Objective:

To examine the association of urine albumin-creatinine ratio (UACR) trajectories over 5- and 10-year periods with heart failure (HF), atrial fibrillation (AF), and coronary heart disease (CHD), highlighting the significance of these associations in cardiovascular risk assessment.

Key Findings:

• Three distinct UACR trajectory groups identified: 'slow rise at low level', 'slow rise at medium level', and 'sustained medium to high' (or 'rapid rise'). These findings suggest varying levels of cardiovascular risk associated with each trajectory.
• Participants in the 'sustained medium to high' group showed 1.5- to 3.7-fold higher risks of HF, AF, and CHD, indicating the need for targeted monitoring and intervention.
• The 'rapid rise' group also exhibited elevated risks for HF and related conditions, emphasizing the importance of early detection.
• 30% to 40% of participants were normoalbuminuric at baseline but developed elevated UACR over time, highlighting the dynamic nature of cardiovascular risk.
• Associations remained significant for HF and HFpEF after censoring for interim AF or CHD, reinforcing the robustness of the findings.

Interpretation:

Progressive increases in UACR are indicative of elevated cardiovascular risk, particularly for heart failure, and can occur even in individuals with initially normal UACR levels, suggesting the need for regular monitoring.

Limitations:

• The study relies on a specific cohort from the MESA study, which may limit generalizability; further research is needed to validate findings in diverse populations.
• Potential confounding factors, such as lifestyle and genetic predispositions, were not accounted for in the analysis, which could influence the observed associations.

Conclusion:

Longitudinal UACR trajectories are crucial for identifying individuals at risk for cardiovascular events, emphasizing the importance of monitoring albuminuria over time to inform clinical decision-making.