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October 25, 2024Scientific ReportsOpen Access

Persistent proteinuria is associated with the occurrence of cardiovascular disease: a nationwide population-based cohort study

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Why the study?

Proteinuria is an important risk factor for CVD, but the association between changes in proteinuria and the occurrence of CVD needed to be determined.

Does the change in proteinuria status (improvement, progression, or persistence) affect the risk of composite cardiovascular disease in the general population?

Population

1,708,712 participants who consecutively underwent national health examinations

Comparison

Proteinuria-improved vs proteinuria-progressed vs proteinuria-persistent vs normal

Design

Nationwide population-based cohort study

Follow-up

Median of 14.2 years

Key result

Persistent proteinuria significantly increased the risk of composite cardiovascular disease compared to normal proteinuria status (HR 1.78).

Authors

HWHo Geol WooMPMoo‐Seok ParkTSTae-Jin Song

Discussion

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Overview

Improvement in proteinuria status was associated with lower CVD risk than persistence or progression; hypothesis-generating and requires prospective validation.

Study Design

Type

Cohort (n=1,708,712)

Structured PICO

Does the change in proteinuria status (improvement, progression, or persistence) affect the risk of composite cardiovascular disease in the general population?

P
Population
1,708,712 participants aged >40 years who consecutively underwent national health examinations from 2003-2004 to 2005-2006, mean age 44.0 years, 69.0% male, from a Korean nationwide population-based cohort.
I
Intervention
Changes in proteinuria status (proteinuria-improved, proteinuria-progressed, or proteinuria-persistent) based on dipstick test at two consecutive health examinations.
C
Comparator
Normal proteinuria group (0 → 0).
O
Outcome
Composite cardiovascular disease (CVD), including all-cause death, all strokes (ischemic and hemorrhagic), and myocardial infarction.composite

Main Result

Effect estimate: HR 1.78 (95% CI 1.64-1.94)

p-value: p=<0.001

Persistent proteinuria is associated with an increased risk of cardiovascular disease, while improvement in proteinuria status lowers this risk compared to persistent or progressed states.

Limitations

  • Retrospective observational design with potential selection bias
  • Use of semi-quantitative urine dipstick test which is prone to false positives
  • Lack of quantitative proteinuria measurements like urine protein-to-creatinine or albumin-to-creatinine ratios
  • Missing data on HbA1c, medication information, and baseline estimated glomerular filtration rate
  • Potential variations in visual reading of dipstick strips and confounding by exercise or infection
  • Inability to confirm causal relationships due to observational nature

Cite This Study

Woo et al. (2024) conducted a cohort in Cardiovascular disease (n=1,708,712). Persistent proteinuria vs. Normal proteinuria was evaluated on Composite cardiovascular disease (all-cause death, all strokes, and myocardial infarction) (HR 1.78, 95% CI 1.64-1.94, p=<0.001). Persistent proteinuria significantly increased the risk of composite cardiovascular disease compared to normal proteinuria status (HR 1.78).

synapsesocial.com/papers/6a17a15acf49e78c48b4467ahttps://doi.org/10.1038/s41598-024-75384-3
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