Proteinuria and Reduced Estimated Glomerular Filtration Rate Independently Predict Risk for Acute Myocardial Infarction: Findings from a Population-Based Study in Keelung, Taiwan.
BACKGROUND
The aim of this study was to evaluate the independent roles of proteinuria and reduced estimated glomerular filtration rate (GFR) in the development of acute myocardial infarction in a northern Taiwanese population.


METHODS
We conducted a community-based prospective cohort study in Keelung, the northernmost county of Taiwan. A total of 63,129 subjects (63% women) ≥ 20 years of age who had no history of coronary heart disease were recruited and followed-up. Univariate and multivariate proportional hazards regression analysis was performed to assess the association between proteinuria and estimated GFR and the risk of acute myocardial infarction.


RESULTS
There were 305 new cases of acute myocardial infarction (114 women and 191 men) documented during a four-year follow-up period. After adjustment of potential confounding covariates, heavier proteinuria (dipstick urinalysis reading 3+) and estimated GFR of less than 60 ml/min/1.73 m(2) independently predicted increased risk of developing acute myocardial infarction. The adjusted hazard ratio (aHR) of heavier proteinuria for occurrence of acute myocardial infarction was 1.85 [95% confidence intervals (CI), 1.17-2.91, p < 0.01] (vs. the reference group: negative dipstick proteinuria). The aHR of estimated GFR of 30-59 ml/min/1.73 m(2) for occurrence of acute myocardial infarction was 2.4 (95% CI, 1.31-4.38, p < 0.01) (vs. the reference group: estimated GFR ≥ 90 ml/ min/1.73 m(2)), and that of estimated GFR of 15-29 ml/min/1.73 m(2) was 5.26 (95% CI, 2.26-12.26, p < 0.01).


CONCLUSIONS
We demonstrated that both heavier proteinuria and lower estimated GFR are significant independent predictors of developing future acute myocardial infarction in a northern Taiwanese population.


BACKGROUND
Acute myocardial infarction; Estimated glomerular filtration rate; Proteinuria.
Division of Cardiology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan; ; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University;
Shu-Hsuan
SH
Chang
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital; ; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University;
Chia-Ti
CT
Tsai
School of Oral Hygiene, College of Oral Medicine, Taipei Medical University;
Amy Ming-Fang
AM
Yen
Division of Cardiology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Yilan;
Meng-Huan
MH
Lei
Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health;
Hsiu-Hsi
HH
Chen
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital; ; Division of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Chuen-Den
CD
Tseng