February 2020

CARDIOVASCULAR

INVESTIGATING RISK OF HEART FAILURE THROUGH ADULTHOOD

Featuring: Ravi Patel, ’12 MD
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​​High levels of albumin, a protein created by the liver, that are found in one’s urine may indicate a higher risk of heart failure later in life, according to a study published in JAMA Cardiology.
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Albumin is the most abundant protein in the bloodstream, ensuring that extracellular fluid is stabilized throughout the body. It’s also a vehicle for vital substances to travel throughout the body, such as hormones, vitamins and enzymes.

Under normal conditions, albumin remains in one’s blood circulation, but a higher presence of albumin found in one’s urine, also known as albuminuria, is considered abnormal — indicating that the endothelium, or inner lining of one’s blood vessels, is dysfunctional.

Previously, albuminuria has been shown to be associated with a higher risk of adverse cardiovascular outcomes including heart failure, according Ravi Patel, ’12 MD, a clinical fellow in cardiovascular medicine and first author of the study.

In the current study, the authors aimed to identify groups of young adults who had similar patterns of change in the levels of albumin in their urine and, ultimately, if those patterns were associated with adverse cardiovascular outcomes later in life.

Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study — a prospective data analysis involving 5,000 black and white young adults who were examined for over 30 years — the authors were able to track distinct patterns of change in levels of albumin in the urine of 2,600 individuals over a period of 20 years.

Of the study participants, five distinct trajectory groups of albuminuria were identified. Two of these groups showed a rapid increase in their level of albumin in the urine. By the end of the 20 years, those individuals with rapid increases in albuminuria had the most severe derangements in cardiac structure and function, which deemed concerning for the development of subclinical heart failure.

“These findings were surprising, because if one simply looked at an individual’s earliest measurement of albuminuria, one wouldn’t be able to predict to what group an individual belonged,” Patel said. “It was only through serial measurements of albuminuria and follow-up that these groups truly identified themselves as high risk.”
In addition to their findings, Patel noted that the study highlights the importance of testing albumin levels in patients with diabetes and in those who have high-risk hypertension and may benefit from medications that prevent adverse cardiac outcomes in the long-term.

This work was supported by the grant T32HL069771 from the National Heart, Lung, and Blood Institute.

This article was originally published in the Feinberg School of Medicine News Center on February 27, 2020. 
Ravi Patel, ’12 MD, a clinical fellow in Cardiovascular Medicine, was first author of the study published in JAMA Cardiology.

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