Abstract
BackgroundThe relationship between changes in proteinuria and myocardial infarction (MI) remains unclear in people with diabetes or pre-diabetes. We aimed to evaluate the predictive value and independent role of changes in proteinuria over a 2-year period in the incidence of MI in people with diabetes or pre-diabetes.MethodsBased on the baseline and 2-year dipstick screening results from the Kailuan prospective cohort study, participants were divided into four categories: no proteinuria, remittent proteinuria, incident proteinuria, and persistent proteinuria. Four multivariable Cox proportional hazard models were built to adjust for the effects of different confounding covariates.ResultsAmong the 17,625 participants in this study, there were a total of 238 incidents of MI during a median follow-up of 6.69 years. After adjusting for demography factors and laboratory indices, the association between persistent proteinuria and MI incidence was maintained (hazard ratio [HR] 2.50, 95% confidence interval [CI] 1.48–4.22). Every decrease of proteinuria from 2006 to 2008 was observed to be responsible for a 21% decline of MI incidence (HR 0.79, 95% CI 0.68–0.90). The interaction between changes in proteinuria and diabetes was confirmed with no effect on MI (P = 0.3371).ConclusionsPersistent proteinuria is an independent risk factor for MI incidence in the pre-diabetic and diabetic population. These findings may help clinicians to interpret proteinuria changes in the outpatient setting and provide possible preventive approaches for people with pre-diabetes or diabetes.
Highlights
The relationship between changes in proteinuria and myocardial infarction (MI) remains unclear in people with diabetes or pre-diabetes
Four multivariable Cox proportional hazard models were built to adjust for the effects of confounding covariates: (1) Model 1: unadjusted; (2) Model 2: adjusted for age and gender; (3) Model 3: adjusted for age, gender, level of education, income, smoking, alcohol abuse, amount of physical activity and body mass index (BMI); (4) Model 4: adjusted for variables in model 3 plus hypertension, diabetes mellitus, dyslipidemia, anti-hypertension agents, anti-diabetic agents, anti-lipidemic agents, systolic blood pressure (SBP), heart rate, high-sensitive C-reactive protein (CRP), Total cholesterol (TC), TG, low-density lipoprotein (LDL), high-density lipoprotein (HDL), Fasting plasma glucose (FPG) and Estimated glomerular filtration rate (eGFR)
Compared with participants with no proteinuria, participants in the other groups had a higher proportion of men, lower educational levels, lower incomes, less drinking, a higher BMI and a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia
Summary
The relationship between changes in proteinuria and myocardial infarction (MI) remains unclear in people with diabetes or pre-diabetes. We aimed to evaluate the predictive value and independent role of changes in proteinuria over a 2-year period in the incidence of MI in people with diabetes or pre-diabetes. Previous studies did not give consideration to how proteinuria changes (none, remittent, incident and persistent) over time and its potential impact on the future risk for the incidence of MI. Several studies have shown that people with diabetes and pre-diabetes are at high risk of developing MI accompanied by proteinuria [13, 14]. This study used a large Chinese population from the Kailuan prospective study to evaluate the predictive value and independent role of proteinuria changes over a 2-year period in the incidence of MI in people with diabetes or pre-diabetes
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