Proteinuria Linked to Increased Risk of Atrial Fibrillation Across All Glycemic Stages: Study Finds

"The risk was similar between those with new-onset and established diabetes. As proteinuria worsened, the incidence of AF increased from 2.46 to 8.18 per 1,000 person-years, emphasizing proteinuria as a crucial marker for assessing AF risk in DM patients," the researchers reported in Cardiovascular Diabetology.

Atrial fibrillation is the most common sustained cardiac arrhythmia, with several known risk factors contributing to its development. Proteinuria and diabetes mellitus are both well-established cardiovascular risk factors that independently elevate the risk of AF. In light of this, Eue-Keun Choi, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea, and colleagues sought to explore the relationship between proteinuria and the risk of incident AF across different glycemic stages.

For this purpose, the researchers selected a cohort of 4,044,524 individuals without a history of atrial fibrillation or type 1 diabetes from the 2009 Korean National Health Insurance Service health checkup data. The participants were categorized into five glycemic stages: normal, prediabetes, new-onset DM, early DM (< 5 years), and late DM (≥ 5 years). Proteinuria was assessed using a urine dipstick test, and the development of incident AF was monitored until 2023.

The study led to the following findings:

• The cohort (mean age 47 ± 14 years, 44.8% female) showed increasing annual AF incidence rates from 2.05 to 7.22 per 1,000 person-years as the glycemic stage progressed from normal to late DM.
• AF incidence rates increased from 2.46 to 8.18 per 1,000 person-years as proteinuria worsened.
• Adjusted Cox regression models showed a higher risk of AF with increasing proteinuria across all glycemic stages. The adjusted hazard ratios for urine dipstick 3+/4+ proteinuria were:
  • 1.58 for normal,
  • 1.64 for prediabetes,
  • 2.39 for new-onset DM,
  • 2.12 for early DM,
  • 2.53 for late DM.
• The proteinuria-AF association was stronger in individuals with DM compared to those without, with a similar risk observed between the new-onset and established DM groups.

In conclusion, the authors' study highlights that proteinuria is an independent and significant risk factor for incident atrial fibrillation across all glycemic stages.

"The findings suggest that the risk of AF in patients with diabetes mellitus can be more effectively stratified by measuring proteinuria levels rather than solely focusing on the duration of DM. By tailoring clinical strategies to address proteinuria, healthcare providers may be able to reduce the risk of AF and improve patient outcomes," the researchers wrote.

Reference:

Yeo, M., Lee, SR., Choi, EK. et al. Proteinuria and the risk of Incident atrial fibrillation according to glycemic stages: a nationwide population-based cohort study. Cardiovasc Diabetol 24, 41 (2025). https://doi.org/10.1186/s12933-025-02590-2