Association of proteinuria and hypertension with incident atrial fibrillation in an elderly population: nationwide data from a community-based elderly cohort

Park, Yoon Jung; Yang, Pil-Sung; Yu, Hee Tae; Kim, Tae Hoon; Jang, Eunsun; Uhm, Jae Sun; Pak, Hui Nam; Lee, Moon Hyoung; Lip, Gregory Y.H.; Joung, Boyoung

doi:10.1097/hjh.0000000000002987

Cited by 5 publications

(5 citation statements)

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“…Studies have reported that ameliorating proteinuria reduced the risk of cardiovascular events, 35,36 whereas conflicting results also existed. 34,37 Due to the observational nature of our study, it was therefore difficult to explain the exact mechanism between proteinuria and the risk for incident AF. Proteinuria is widely accepted as a marker reflecting systemic endothelial dysfunction, inflammatory cytokine activation, impaired oxidative metabolism, and insulin resistance.…”

Section: Discussionmentioning

confidence: 95%

“…Similarly, a prior meta-analysis has showed that elevated ACR was significantly associated with a greater risk of incident AF. 11 Park et al 34 showed that participants with persistent proteinuria had higher cumulative incidence of AF compared with the participants who had consistently negative results. These findings highlight that a long-term exposure to proteinuria may significantly increase the risk of AF.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, early detection, diagnosis, and management may be a promising approach to reduce the risk of AF. Studies have reported that ameliorating proteinuria reduced the risk of cardiovascular events, 35,36 whereas conflicting results also existed 34,37 …”

Section: Discussionmentioning

confidence: 99%

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Association of proteinuria and risk of incident atrial fibrillation in the general population: A prospective study of Kailuan study participants

Wang

et al. 2023

Pacing Clinical Electrophis

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Background Proteinuria is a well‐known cardiovascular risk factor, but whether it independently increases the risk for atrial fibrillation (AF) in Chinese population is unknown. To address this deficiency, herein, we investigated the association between proteinuria detected using urine dipstick test and the risk of AF. Methods This was a prospective cohort study of Kailuan study participants who underwent the 2006–2007 and 2010–2011 health checkups and was free from AF. Participants were classified into four groups based on the level of proteinuria: [−, trace (±), 1+, ≥2+]. The outcome was incident AF as confirmed by 12‐lead electrocardiography. Results During a median of 11.90 years of follow‐up, we documented 514 incident AF cases among 60,599 participants. Proteinuria was found in 6302 (10.40%) participants. Relative to participants without proteinuria at the baseline, those with proteinuria (≥2+) had an 83.9% higher risk (95% confidence interval [CI], 1.073–3.154, p = .0267) of developing AF, after adjusted for confounding variables. The result was consistent in the sensitivity analysis. Compared to consistently negative proteinuria, the risk of AF significantly increased in the aggravated proteinuria group (hazard ratio [HR] 1.552, 95% CI 1.140–2.114) and the persistent proteinuria group (HR 2.485, 95% CI 1.414–4.366). Among participants with resolved proteinuria (from positive to negative), the risk of incident AF was not significantly increased compared to those with persistently negative proteinuria (HR 1.300, 95% CI 0.743–2.276). Conclusions Proteinuria could be a modifiable risk factor for predicting AF development. Knowing the presence of proteinuria may improve risk stratification for decision‐making about AF prevention.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Association of proteinuria and risk of incident atrial fibrillation in the general population: A prospective study of Kailuan study participants

Wang

et al. 2023

Pacing Clinical Electrophis

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“…12 In addition, proteinuria is a signi cant determinant in the development of incident AF. 13,14 Meanwhile, proteinuria can develop…”

Section: Introductionmentioning

confidence: 99%

Recovery from Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-based Cohort Study

Chang,

Kang,

et al. 2024

Preprint

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Background: While proteinuria is recognized as a risk factor for atrial fibrillation (AF), it can exhibit both reversible and persistent courses. Our objective was to examine the relationship between the change in status for proteinuria and the risk of AF in a longitudinal cohort study on the general population nationwide. Methods: We included participants (n = 1,708,103) who underwent consecutive health examinations. The presence of proteinuria was determined by dipstick urinalysis results. The outcome was the occurrence of AF (International Classification of Diseases-10 code: I48). Results: All included participants, 1,666,111 (97.5%), 17,659 (1.0%), 19,696 (1.2%), and 4,637 (0.3%), were categorized into groups of proteinuria-free, recovered, developed, and chronic, respectively. The median interval between health screenings was 21.5 months. During a median follow-up of 14.5 years, 41,190 (2.4%) cases of AF occurred. In the multivariable analysis, the risk of AF occurring in the proteinuria-recovered group, (hazard ratio (HR): 1.198, 95% confidence interval (CI): 1.109–1.293, ***P < 0.001), proteinuria-developed group (HR: 1.456, 95% CI: 1.362–1.558, ***P < 0.001) and proteinuria-chronic group (HR: 1.656, 95% CI: 1.476–1.858, ***P < 0.001), were higher than in the proteinuria-free group. In a further pairwise comparison, the proteinuria-recovered group had a relatively lower risk of AF compared to the proteinuria-chronic group (HR: 0.751, 95% CI: 0.652–0.865, ***P < 0.001). Conclusion: Our study showed that the risk of AF can change according to alterations in proteinuria status. Notably, recovering from proteinuria can also be considered a modifiable risk factor for AF.

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“…About 60-80% of AF patients have HBP (2), and persistently elevated blood pressure (BP) is one of the important risk factors for AF (3)(4)(5). Conversely, patients with HBP are about several times more likely to develop AF than those with normal BP (6,7). Studies have also shown that high normal BP increases the risk of AF in middle-aged individuals (6,8).…”

Section: Introductionmentioning

confidence: 99%

Sex differences in the association between blood pressure and atrial fibrillation: A case-control study

Zhao

Feng

Wahid

et al. 2022

Front. Cardiovasc. Med.

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BackgroundTo examine the association of hypertension (HBP) and its control with atrial fibrillation (AF) and how patient sex affects this association.Materials and methodsA case control study of patients admitted to our hospital from 2015 to 2019 was conducted. Patients were divided into subgroups according to their blood pressure (BP) levels and control status, in which odd ratios (OR) by sex for AF was estimated using a logistic regression model and restrictive cubic splines before and after propensity score matching.ResultsA total of 3,212 patients with AF and 8,307 without AF were investigated. Compared to patients with normal BP, patients with HBP had more AF [OR = 1.75 (1.52–2.02), OR = 2.66 (2.24–3.15), and OR = 4.30 (3.40–5.44) in patients with grade 1, 2, and 3 HBP, respectively]. In HBP patients with grade 3, the OR of AF was much higher in women than in men (OR = 7.15, 95% CI: 4.43–11.50 vs. OR = 2.48, 95% CI: 1.66–3.72). BP over 133.1/79.9 mmHg in men or 127.1/75.1 mmHg in women was positively associated with AF. In patients with HBP, uncontrolled BP was more associated with AF (OR = 3.00, 95% CI: 2.53–3.56), especially in women (OR = 3.09, 95% CI: 2.27–4.19). BP and prevalence of AF correlated with each other positively in patients admitted to a cardiology ward. Lowering BP to 145.1/85.8 mmHg in men or 140.5/82.5 mmHg in women led to less AF.ConclusionThere is more significant relationship between HBP and AF in female patients. A lower and individualized BP target may be formulated to prevent AF in women.

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Association of proteinuria and hypertension with incident atrial fibrillation in an elderly population: nationwide data from a community-based elderly cohort

Cited by 5 publications

References 33 publications

Association of proteinuria and risk of incident atrial fibrillation in the general population: A prospective study of Kailuan study participants

Association of proteinuria and risk of incident atrial fibrillation in the general population: A prospective study of Kailuan study participants

Recovery from Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-based Cohort Study

Sex differences in the association between blood pressure and atrial fibrillation: A case-control study

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