# Improved Proteinuria May Attenuate the Risk of Atrial Fibrillation: A Nationwide Population-Based Cohort Study

## TL;DR

This study shows that improving proteinuria can reduce the risk of atrial fibrillation in a large population.

## Contribution

The study demonstrates that recovery from proteinuria is a modifiable risk factor for atrial fibrillation.

## Key findings

- Participants with improved proteinuria had a 24.9% lower risk of AF compared to those with persistent proteinuria.
- The risk of AF increased with the initial severity of proteinuria in both improved and persistent groups.
- Proteinuria status changes over time are linked to AF risk in the general population.

## Abstract

Background/Objectives: Proteinuria is documented as a risk factor for atrial fibrillation (AF) and can manifest in either reversible or continued forms. Our objective was to examine the relationship between the change in status for proteinuria and the risk of AF in a longitudinal cohort study on the general population nationwide. Methods: We included participants (n = 1,708,103) who underwent repetitive health examinations. The presence of proteinuria was determined by dipstick urinalysis results. The outcome was the occurrence of AF (International Classification of Diseases-10 code: I48). Results: All included participants, 1,666,111 (97.5%), 17,659 (1.0%), 19,696 (1.2%), and 4637 (0.3%), were categorized into groups of proteinuria-free, improved, progressed, and persistent, respectively. During a median follow-up of 14.5 years, 41,190 (2.4%) cases of AF occurred. In the multivariable analysis, the risk of AF was increased as the initial severity was more severe in the proteinuria-improved and proteinuria-persistent groups (p for trend < 0.001). In a further pairwise comparison, the proteinuria-improved group had a relatively lower risk of AF compared to the proteinuria-persistent group (HR: 0.751, 95% CI: 0.652–0.865, p < 0.001). Conclusions: Our study showed that the risk of AF can change according to alterations in proteinuria status. Notably, recovering from proteinuria can also be considered a modifiable risk factor for AF.