Association of Blood Urea Nitrogen With Incident Heart Failure in the Community - The Atherosclerosis Risk in Communities (ARIC) Study.

Abstract

The association between blood urea nitrogen (BUN) levels and incident heart failure (HF) in the general population is still unclear. We assessed the association of BUN level with incident HF in 14,167 ARIC participants without a history of HF at baseline (1987-1989) (mean age 54.1 years, 54.4% female, 25.2% Black). BUN levels (mg/dL) were divided into quartiles, with the highest quartile further divided into tertiles (Q1 ≤13, Q2 13-15, Q3 15-17, Q4a 17-19, Q4b 19-21, Q4c >21). HF events were identified through to December 31, 2019, using diagnostic codes on discharge records or death certificates. Hazard ratios (HRs) were estimated using multivariable Cox models. During a median follow-up of 26.2 years, 3,482 participants developed HF (incidence rate 10.7 per 1,000 person-years). In a multivariable Cox model adjusted for sociodemographic variables, the highest BUN quartile (Q4) had a HR of 1.19 (95% confidence interval [CI] 1.09, 1.31) compared with Q1. HRs for Q4a, Q4b, and Q4c were 1.14 (95% CI 1.02, 1.28), 1.11 (0.96, 1.28), and 1.42 (1.22, 1.63), respectively. After further adjustment for clinical factors, the association remained significant for Q4c (HR 1.23 [1.06, 1.43]). Associations were consistent across demographic and clinical subgroups. In this community-based cohort, higher BUN levels were significantly associated with incident HF. BUN, routinely measured in clinical care, may help identify individuals at risk of HF.