title: Serum Bicarbonate Is Associated with Heart Failure in the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Low serum bicarbonate concentrations are associated with mortality and kidney disease progression. Data regarding associations between bicarbonate and cardiovascular disease (CVD) are scarce.
  
  
  METHODS
  We performed a cohort study of 6,229 adult participants from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort free of CVD at baseline. Serum bicarbonate was measured at baseline. Cardiovascular outcomes were defined as: (1) subclinical CVD (left ventricular mass [LVM] and aortic pulse pressure [PP] measured at baseline), (2) incident atherosclerotic cardiovascular events (CVE; composite of myocardial infarction, resuscitated cardiac arrest, stroke, coronary heart disease death, and stroke death), and (3) incident heart failure.
  
  
  RESULTS
  During a median (interquartile range) follow-up of 8.5 (7.7-8.6) years, 331 (5.3%) participants had an incident CVE and 174 (2.8%) developed incident heart failure. We stratified analyses by use of diuretics because we observed a significant interaction between diuretic use and bicarbonate with study outcomes. Among diuretic nonusers, with adjustment, bicarbonate ≥25 mEq/L was associated with an estimated 3.0 g greater LVM (95% CI 0.5-5.0) and 1.0 mm Hg higher aortic PP (95% CI 0.4-2.0) compared to bicarbonate 23-24 mEq/L. Each 1 mEq/L of bicarbonate increase was associated with a 13% higher risk of incident heart failure (hazards ratio 1.13, 95% CI 1.01-2.11). Among diuretic users, higher bicarbonate was not associated with CVD. Bicarbonate was not associated with incident atherosclerotic CVE irrespective of diuretic use.
  
  
  CONCLUSIONS
  Among nonusers of diuretics in a large community-based study, higher serum bicarbonate concentrations are associated with subclinical CVD and new heart failure.
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Kendrick
authors.forename: Leila
authors.initials: L
authors.lastname: Zelnick
authors.forename: Michel B
authors.initials: MB
authors.lastname: Chonchol
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Hoofnagle
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
authors.forename: Mark
authors.initials: M
authors.lastname: Sarnak
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000097:blood / Q000150:complications* / Q000208:ethnology; D001639:Bicarbonates / Q000097:blood*; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006333:Heart Failure / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents; D001639:Bicarbonates; D004232:Diuretics; D003404:Creatinine