Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama.
JACC Heart Fail. 2019 May;7(5):394-401. doi: 10.1016/j.jchf.2019.01.016.
This study examined the association between urinary albumin excretion and incident heart failure (HF) hospitalization.
Excess urinary albumin excretion is more strongly associated with incident stroke and coronary heart disease risk in black than in white individuals. Whether similar associations extend to HF is unclear.
This study examined the associations between the urinary albumin-to-creatinine ratio (ACR) and incident hospitalization for HF overall in 24,433 REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants free of suspected HF at baseline; findings were stratified by race and HF subtype (preserved vs. reduced ejection fraction). Models were adjusted for sociodemographic, clinical, and laboratory variables including estimated glomerular filtration rate, and multiple imputation was used to account for missing covariate data.
After a median follow-up of 9.2 years, 881 incident HF events (332 preserved ejection fraction, 447 reduced ejection fraction, 102 unspecified) were observed. Compared to the lowest ACR category (<10 mg/g), the risk of incident HF increased with increasing ACR categories (10 to 29 mg/g hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.26 to 1.78; 30 to 300 mg/g HR: 2.32; 95% CI: 1.93 to 2.78; >300 mg/g HR: 4.42; 95% CI: 3.36 to 5.83) in the fully adjusted model. Results did not differ by race. The magnitude of the association between ACR and HF with preserved ejection fraction was greater than with HF with reduced ejection fraction (HR comparing highest vs. lowest ACR category: 6.20; 95% CI: 4.15 to 9.26 vs. HR: 4.37; 95% CI: 3.00 to 6.25, respectively; p = 0.05).
Higher ACR was associated with greater risk of incident HF hospitalization in community-dwelling black and white adults.
本研究旨在探讨尿白蛋白排泄与心力衰竭（HF）住院事件之间的关联。
与白人个体相比，黑人个体尿白蛋白排泄量超标与中风和冠心病风险的相关性更强。但这种关联是否同样适用于 HF 尚不清楚。
本研究纳入了 24433 名 REGARDS（地理和种族差异导致中风的原因）研究参与者，这些参与者在基线时无疑似 HF，研究检测了他们的尿白蛋白与肌酐比值（ACR）与 HF 住院事件之间的总体关联；并按种族和 HF 亚型（射血分数保留型与射血分数降低型）进行分层。模型调整了社会人口统计学、临床和实验室变量，包括估算肾小球滤过率，采用多重插补法处理缺失的协变量数据。
中位随访 9.2 年后，共观察到 881 例 HF 事件（射血分数保留型 332 例，射血分数降低型 447 例，未特指型 102 例）。与最低 ACR 类别（<10mg/g）相比，随着 ACR 类别的增加（10-29mg/g 的风险比 [HR]：1.49；95%置信区间 [CI]：1.26 至 1.78；30-300mg/g 的 HR：2.32；95%CI：1.93 至 2.78；>300mg/g 的 HR：4.42；95%CI：3.36 至 5.83），HF 住院事件的风险增加，在完全调整的模型中结果一致。种族间无差异。ACR 与射血分数保留型 HF 之间的关联强度大于射血分数降低型 HF（最高 ACR 类别与最低 ACR 类别相比的 HR：6.20；95%CI：4.15 至 9.26 与 HR：4.37；95%CI：3.00 至 6.25，分别；p=0.05）。
在社区居住的黑人和白人成年人中，较高的 ACR 与 HF 住院事件风险增加相关。
