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Joint Association of Albuminuria and Left Ventricular Hypertrophy With Incident Heart Failure in Adults at High Risk

Muhammad Imtiaz Ahmad1, Richard Kazibwe2, Mai Z Soliman3

  • 1Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin.

The American Journal of Cardiology
|October 11, 2023
PubMed

Insights

Albuminuria and left ventricular hypertrophy (LVH) are additive predictors of acute decompensated heart failure (ADHF). Their combined presence significantly increases ADHF risk more than either condition alone.

Area of Science:

  • Cardiology
  • Nephrology
  • Clinical Medicine

Background:

  • Albuminuria and left ventricular hypertrophy (LVH) are known independent risk factors for heart failure (HF).
  • The combined impact of albuminuria and LVH on the risk of acute decompensated heart failure (ADHF) has not been previously investigated.

Purpose of the Study:

  • To investigate the joint association of albuminuria and electrocardiographic-LVH with incident ADHF.
  • To determine if combinations of albuminuria and LVH modify the effectiveness of blood pressure control in reducing ADHF risk.

Main Methods:

  • Analysis of 8,511 participants from the Systolic Blood Pressure Intervention Trial (SPRINT).
  • Electrocardiographic-LVH defined by Cornell voltage, Cornell voltage product, or Sokolow-Lyon criteria.
  • Albuminuria defined as urine albumin/creatinine ratio ≥30 mg/g.
  • Cox proportional hazard models used to assess risk associations.

Main Results:

  • Concomitant albuminuria and LVH showed a significantly greater risk of ADHF compared to either condition alone (HR 4.95 [3.22 to 7.62]).
  • An additive interaction was observed between albuminuria and LVH in predicting ADHF (p=0.01).
  • Intensive blood pressure control's benefit in reducing ADHF was attenuated in participants with both albuminuria and LVH, though no significant interaction was found (p=0.26).

Conclusions:

  • Albuminuria and LVH are additive predictors of ADHF.
  • The combination of albuminuria and LVH presents a substantially elevated risk for ADHF.
  • Intensive blood pressure control's efficacy in mitigating ADHF risk did not significantly differ across albuminuria/LVH categories.

Keywords:
SPRINTalbuminuriaheart failureleft ventricular hypertrophy

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