Albuminuria Trajectories Predict Heart Failure, AF, and CHD Risks: MESA Study Insights

Overview

This study identified distinct urine albumin-creatinine ratio (UACR) trajectories over 5- and 10-year periods that are strongly associated with increased risks of heart failure (HF), atrial fibrillation (AF), and coronary heart disease (CHD). Notably, individuals with sustained medium to high or rapidly rising UACR levels had elevated cardiac biomarkers and myocardial fibrosis, indicating subclinical cardiac damage even when baseline UACR was normal.

Background

Cardiovascular diseases remain the leading cause of morbidity and mortality globally, with heart failure (HF), atrial fibrillation (AF), and coronary heart disease (CHD) being prevalent in older adults. Albuminuria, an early marker of kidney glomerular injury, is linked to increased cardiovascular risk, including HF, even at levels below clinical thresholds. Prior studies mostly used single UACR measurements, leaving the impact of longitudinal UACR changes on cardiovascular outcomes unclear. This study addresses these gaps by analyzing UACR trajectories and their associations with subclinical and clinical cardiovascular conditions.

Data Highlights

Key Findings

• Three distinct UACR trajectory groups were identified over 5- and 10-year periods: slow rise at low level, slow rise at medium level, and sustained medium to high or rapid rise.
• Participants in the sustained medium to high (5-year) and rapid rise (10-year) groups (~8%) had 1.5- to 3.7-fold increased risks of HF, HF subtypes, AF, and CHD.
• Approximately 30-40% of high-risk participants were normoalbuminuric at baseline but developed elevated UACR over time.
• Associations with HF and HFpEF remained significant even after censoring for interim AF or CHD events, but not for HFrEF.
• Elevated cardiac biomarkers (NT-proBNP and hs-TnT) and increased myocardial interstitial fibrosis (native T1 and extracellular volume fraction) were observed in high-risk UACR trajectory groups.
• Most associations were independent of baseline UACR levels, highlighting the prognostic value of longitudinal UACR monitoring.

Clinical Implications

Monitoring longitudinal changes in UACR can identify individuals at elevated risk for heart failure, particularly HFpEF, as well as atrial fibrillation and coronary heart disease, even when baseline albuminuria is normal. Early detection of rising albuminuria trajectories may prompt closer cardiovascular evaluation and preventive interventions. Incorporating serial UACR measurements into clinical practice could enhance risk stratification and guide management to mitigate progression to overt cardiovascular disease.

Conclusion

Distinct longitudinal patterns of albuminuria are strong predictors of subclinical and clinical cardiovascular disease, especially heart failure and its preserved ejection fraction subtype. These findings support the utility of repeated UACR assessments to improve early identification of individuals at high cardiovascular risk.

References

1. MESA Study Authors 2024 -- Analysis of Albuminuria Patterns and Their Association with Subclinical and Clinical Heart Failure, Atrial Fibrillation, and Coronary Heart Disease