Ingelsson Erik, Sundström Johan, Lind Lars, Risérus Ulf, Larsson Anders, Basu Samar, Arnlöv Johan
Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Uppsala, Sweden.
Eur Heart J. 2007 Jul;28(14):1739-45. doi: 10.1093/eurheartj/ehm130. Epub 2007 May 11.
To investigate associations of urinary albumin excretion rate (UAER) and heart failure (HF) incidence in a community-based sample.
In a prospective study of 70-year-old men free from HF at baseline (n = 1106), UAER (from timed overnight samples) was analysed with established risk factors for HF [acute MI before baseline, acute MI during follow-up (modelled as a time-dependent covariate), hypertension, diabetes, left ventricular hypertrophy, smoking, body mass index, and glomerular filtration rate] and more recently described risk factors [high-sensitive C-reactive protein and insulin sensitivity (clamp glucose disposal rate)] as predictors of HF incidence. Ninety-eight participants developed HF during a median follow-up of 9.0 years. In Cox proportional hazards models adjusted for established and novel risk factors for HF, a 1 SD increase in log UAER increased the risk of HF in individuals without anti-hypertensive treatment (hazard ratio 1.49; 95% CI 1.13-1.98; P = 0.005). Furthermore, UAER remained an independent predictor of HF, also in participants without diabetes at baseline or myocardial infarction at baseline or during follow-up. There were no significant associations between UAER and HF incidence in individuals with anti-hypertensive treatment.
Our observations support the notion that low-grade albuminuria is a marker for subclinical cardiovascular damage that predisposes to future HF in the community.
在一个基于社区的样本中研究尿白蛋白排泄率（UAER）与心力衰竭（HF）发生率之间的关联。
在一项对基线时无HF的70岁男性（n = 1106）的前瞻性研究中，分析了UAER（来自定时过夜样本）与已确定的HF危险因素[基线前急性心肌梗死、随访期间急性心肌梗死（建模为时间依赖性协变量）、高血压、糖尿病、左心室肥厚、吸烟、体重指数和肾小球滤过率]以及最近描述的危险因素[高敏C反应蛋白和胰岛素敏感性（钳夹葡萄糖处置率）]作为HF发生率的预测因素。98名参与者在中位随访9.0年期间发生了HF。在针对已确定和新的HF危险因素进行调整的Cox比例风险模型中，log UAER每增加1个标准差，未接受抗高血压治疗的个体发生HF的风险增加（风险比1.49；95%CI 1.13 - 1.98；P = 0.005）。此外，UAER仍然是HF的独立预测因素，在基线时无糖尿病或基线或随访期间无心肌梗死的参与者中也是如此。在接受抗高血压治疗的个体中，UAER与HF发生率之间无显著关联。
我们的观察结果支持以下观点，即轻度蛋白尿是亚临床心血管损伤的标志物，这种损伤使社区中个体未来易发生HF。
