Proteinuria and Reduced Estimated Glomerular Filtration Rate Independently Predict Risk for Acute Myocardial Infarction: Findings from a Population-Based Study in Keelung, Taiwan

Background: The aim of this study was to evaluate the independent roles of proteinuria and reduced estimated glomerular filtration rate (GFR) in the development of acutemyocardial infarction in a northern Taiwanese population. Methods: We conducted a community-based prospective cohort study in Keelung, the northernmost county of Taiwan. A total of 63,129 subjects (63% women) 20 years of age who had no history of coronary heart disease were recruited and followed-up. Univariate and multivariate proportional hazards regression analysiswas performed to assess the association between proteinuria and estimated GFR and the risk of acute myocardial infarction. Results: There were 305 new cases of acutemyocardial infarction (114women and 191 men) documented during a four-year follow-up period. After adjustment of potential confounding covariates, heavier proteinuria (dipstick urinalysis reading 3+) and estimated GFR of less than 60ml/min/1.73m2 independently predicted increased risk of developing acute myocardial infarction. The adjusted hazard ratio (aHR) of heavier proteinuria for occurrence of acute myocardial infarction was 1.85 [95% confidence intervals (CI), 1.17-2.91, p ＜ 0.01] (vs. the reference group: negative dipstick proteinuria). The aHR of estimated GFR of 30-59 ml/min/1.73 m2 for occurrence of acute myocardial infarction was 2.4 (95% CI, 1.31-4.38, p ＜ 0.01) (vs. the reference group: estimated GFR 90 ml/ min/1.73 m2), and that of estimated GFR of 15-29 ml/min/1.73 m2 was 5.26 (95% CI, 2.26-12.26, p ＜ 0.01). Conclusions: We demonstrated that both heavier proteinuria and lower estimated GFR are significant independent predictors of developing future acute myocardial infarction in a northern Taiwanese population.