Improved Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Total | Groups According to the Change in Proteinuria | ||||
---|---|---|---|---|---|---|
Proteinuria-Free | Proteinuria-Improved | Proteinuria-Progressed | Proteinuria-Persistent | p-Value | ||
Number of participants (%) | 1,708,103 | 1,666,111 (97.54) | 18,759 (1.10) | 20,936 (1.23) | 2297 (0.13) | |
Age, years | 44.0 ± 12.09 | 43.92 ± 12.06 | 47.01 ± 13.19 | 47.01 ± 13.05 | 49.43 ± 12.44 | <0.001 |
Sex | <0.001 | |||||
Male | 1,178,673 (69.00) | 1,150,995 (69.08) | 11,930 (63.6) | 13,943 (66.60) | 1816 (78.48) | |
Female | 529,430 (31.00) | 515,116 (30.92) | 6829 (36.4) | 6993 (33.40) | 498 (21.52) | |
Body mass index (kg/m2) | 23.63 ± 3.03 | 23.61 ± 3.02 | 24.18 ± 3.33 | 24.25 ± 3.45 | 24.89 ± 3.34 | <0.001 |
Household income | <0.001 | |||||
First quartile, lowest | 255,667 (14.97) | 248,768 (14.93) | 3261 (17.38) | 3342 (15.96) | 297 (12.83) | |
Second quartile | 633,817 (37.11) | 619,240 (37.17) | 6613 (35.25) | 7288 (34.81) | 680 (29.39) | |
Third quartile | 564,014 (33.02) | 550,552 (33.04) | 5891 (31.4) | 6763 (32.3) | 815 (35.22) | |
Fourth quartile, highest | 254,605 (14.91) | 247,551 (14.86) | 2994 (15.96) | 3543 (16.92) | 522 (22.56) | |
Smoking status | <0.001 | |||||
Never | 984,134 (57.62) | 958,655 (57.54) | 11,620 (61.94) | 12,625 (60.3) | 1246 (53.85) | |
Former | 212,855 (12.46) | 207,726 (12.47) | 2216 (11.81) | 2546 (12.16) | 370 (15.99) | |
Current | 511,114 (29.92) | 499,730 (29.99) | 4923 (26.24) | 5765 (27.54) | 698 (30.16) | |
Alcohol consumption (days/week) | <0.001 | |||||
<3 | 1,143,895 (66.97) | 1,115,187 (66.93) | 12,972 (69.15) | 14,239 (68.01) | 1512 (65.34) | |
≥3 | 564,208 (33.03) | 550,924 (33.07) | 5787 (30.85) | 6697 (31.99) | 802 (34.66) | |
Regular exercise (days/week) | <0.001 | |||||
<3 | 1,377,901 (80.67) | 1,344,948 (80.72) | 14,564 (77.64) | 16,603 (79.3) | 1800 (77.79) | |
≥3 | 330,202 (19.33) | 321,163 (19.28) | 4195 (22.36) | 4333 (20.7) | 514 (22.21) | |
Comorbidities | ||||||
Hypertension | 773,343 (45.27) | 748,007 (44.9) | 11,062 (58.97) | 12,529 (59.84) | 1762 (76.15) | <0.001 |
Diabetes mellitus | 241,826 (14.16) | 230,155 (13.81) | 4991 (26.61) | 5775 (27.58) | 915 (39.54) | <0.001 |
Dyslipidemia | 423,808 (24.81) | 408,103 (24.49) | 6932 (36.95) | 7674 (36.65) | 1113 (48.1) | <0.001 |
Cancer | 31,617 (1.85) | 30,441 (1.83) | 536 (2.86) | 556 (2.66) | 85 (3.67) | <0.001 |
Renal disease | 17,424 (1.02) | 15,207 (0.91) | 1002 (5.34) | 934 (4.46) | 283 (12.23) | <0.001 |
Charlson Comorbidity Index | ||||||
0 | 677,173 (39.64) | 663,858 (39.84) | 5941 (31.67) | 6762 (32.3) | 612 (26.45) | <0.001 |
1 | 692,943 (40.57) | 677,737 (40.68) | 6794 (36.22) | 7706 (36.81) | 710 (30.68) | <0.001 |
≥2 | 337,987 (19.79) | 324,516 (19.48) | 6024 (32.11) | 6468 (30.89) | 992 (42.87) | <0.001 |
Number of Events | Event Rate (%) | Incidence Rate (Per 1000 Person Years) | Unadjusted | Multivariable Adjusted (1) | Multivariable Adjusted (2) | ||||
---|---|---|---|---|---|---|---|---|---|
HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | ||||
Atrial Fibrillation | 40,654 | 2.38 | 1.68 | ||||||
Proteinuria-Free: 0 → 0 | 38,857 | 2.33 | 1.64 | 1 (Ref) | 1 (Ref) | 1 (Ref) | |||
Proteinuria-Improved | |||||||||
+1 → 0 | 438 | 3.37 | 2.43 | 1.48 (1.35, 1.63) | <0.001 | 1.11 (1.01, 1.22) | 0.035 | 1.10 (1.00, 1.21) | 0.053 |
+2 → 0 | 172 | 4.42 | 3.23 | 1.98 (1.70, 2.29) | <0.001 | 1.43 (1.23, 1.66) | <0.001 | 1.40 (1.21, 1.63) | <0.001 |
+2 → +1 | 41 | 5.66 | 4.25 | 2.63 (1.93, 3.57) | <0.001 | 1.59 (1.17, 2.16) | 0.003 | 1.56 (1.15, 2.12) | 0.004 |
+3~4 → 0 | 43 | 5.49 | 4.15 | 2.55 (1.89, 3.44) | <0.001 | 1.83 (1.36, 2.47) | <0.001 | 1.80 (1.33, 2.42) | <0.001 |
+3~4 → +1 | 10 | 5.65 | 4.59 | 2.87 (1.54, 5.33) | 0.009 | 1.54 (1.03, 2.04) | 0.017 | 1.53 (1.02, 2.04) | 0.0191 |
+3~4 → +2 | 18 | 9.09 | 7.34 | 4.59 (2.89, 7.29) | <0.001 | 2.53 (1.59, 4.02) | <0.001 | 2.48 (1.56, 3.93) | 0.001 |
Proteinuria-Progressed | |||||||||
0 → +1 | 566 | 4 | 2.91 | 1.78 (1.63, 1.93) | <0.001 | 1.36 (1.26, 1.48) | <0.001 | 1.36 (1.25, 1.47) | <0.001 |
0 → +2 | 238 | 5.21 | 3.87 | 2.38 (2.09, 2.70) | <0.001 | 1.64 (1.44, 1.86) | <0.001 | 1.62 (1.43, 1.84) | <0.001 |
0 → +3~4 | 55 | 5.73 | 4.35 | 2.69 (2.06, 3.50) | <0.001 | 2.07 (1.59, 2.69) | <0.001 | 2.06 (1.58, 2.68) | <0.001 |
+1 → +2 | 46 | 5.91 | 4.46 | 2.74 (2.06, 3.66) | <0.001 | 1.45 (1.09, 1.94) | 0.011 | 1.44 (1.08, 1.93) | 0.013 |
+1 → +3~4 | 17 | 8.59 | 6.93 | 4.33 (2.69, 6.96) | <0.001 | 2.37 (1.48, 3.82) | 0.004 | 2.32 (1.44, 3.74) | 0.005 |
+2 → +3~4 | 16 | 6.08 | 4.71 | 2.92 (1.79, 4.77) | <0.001 | 1.80 (1.10, 2.93) | 0.019 | 1.75 (1.07, 2.86) | 0.024 |
Proteinuria-Persistent | |||||||||
+1 → +1 | 81 | 5.45 | 4.05 | 2.49 (2.01, 3.1) | <0.001 | 1.45 (1.17, 1.8) | 0.008 | 1.43 (1.15, 1.78) | 0.001 |
+2 → +2 | 43 | 6.21 | 4.78 | 2.96 (2.20, 3.99) | <0.001 | 1.65 (1.23, 2.23) | 0.001 | 1.64 (1.22, 2.22) | 0.001 |
+3~4 → +3~4 | 13 | 10.83 | 9.18 | 5.79 (3.36, 9.96) | <0.001 | 3.53 (2.05, 6.08) | <0.001 | 3.47 (2.01, 5.97) | <0.001 |
Status of Proteinuria | Multivariable Adjusted | |
---|---|---|
HR (95% CI) | p Value | |
Improved vs. Free (reference) | 1.233 (1.142, 1.333) | <0.001 |
Progressed vs. Free (reference) | 1.474 (1.383, 1.575) | <0.001 |
Persistent vs. Free (reference) | 1.595 (1.345, 1.886) | <0.001 |
Improved vs. Persistent (reference) | 0.804 (0.673, 0.974) | 0.019 |
Progressed vs. Persistent (reference) | 0.947 (0.786, 1.126) | 0.466 |
Improved vs. Progressed (reference) | 0.847 (0.767, 0.938) | 0.005 |
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Chang, Y.; Kang, M.K.; Song, T.-J. Improved Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study. J. Clin. Med. 2024, 13, 4648. https://doi.org/10.3390/jcm13164648
Chang Y, Kang MK, Song T-J. Improved Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study. Journal of Clinical Medicine. 2024; 13(16):4648. https://doi.org/10.3390/jcm13164648
Chicago/Turabian StyleChang, Yoonkyung, Min Kyoung Kang, and Tae-Jin Song. 2024. "Improved Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study" Journal of Clinical Medicine 13, no. 16: 4648. https://doi.org/10.3390/jcm13164648