Improving major cardiovascular risk factors may reduce the risk for proteinuria and its adverse sequelae in the general population, according to a recent Japanese study.

Investigators assessed the prevalence of 7 cardiovascular health (CVH) metrics in a cohort of 865,087 Japanese adults (median age 46 years; 60.7% men) without proteinuria at baseline using a nationwide population-based database. Ideal CVH metrics included nonsmoking, body mass index less than 25 kg/m2, physical activity at goal, skipping breakfast less than 3 times a week  diet), blood pressure less than 120/80 mm Hg, fasting plasma glucose less than 100 mg/dL, and total cholesterol less than 200 mg/dL.

Low, medium, and high adherence to cardiovascular health was defined as meeting 0-2, 3-4, and 5-7 of these CVH criteria, respectively. Of the cohort, 9.8%, 38.8%, and 51.4% had low, medium, and high adherence.

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Among the 865,087 adults, 41,474 (4.8%) tested positive for proteinuria (1+ or higher) on the urine dipstick test during 4 years of follow-up.

Compared with the low CVH category, the medium and high CVH categories were significantly associated with 39% and 55% decreased odds of proteinuria after adjustment for age and sex, Hidehiro Kaneko, MD, PhD, of The University of Tokyo in Tokyo, Japan, and colleagues reported in the American Journal of Nephrology. Each 1-point increase in the number of CVH components achieved was significantly associated with 17% decreased odds for proteinuria. Except for total cholesterol, all CVH components were significantly associated with decreased odds of proteinuria.

At the 1-year checkup, each 1-point improvement in the number of CVH components achieved was significantly associated with 10% decreased odds of proteinuria onset, the investigators reported.

To the best of our knowledge, this is the first study to show not only the relationship between modifiable risk factors and the future risk of proteinuria, but also the potential of the improvement in modifiable risk factors to prevent the proteinuria development, using a large-scale populationbased dataset,” Dr Kaneko’s team wrote.

In a second study of 1,849,074 Japanese adults without proteinuria at baseline (median age 45 years; 59.3% men) from the same database published in the American Journal of Nephrology, Dr Kaneko and colleagues found that both prediabetes and diabetes were significantly associated with 1.1- and 2.2-fold increased risk for proteinuria.

The investigators cautioned that study results from Japanese cohorts may not apply to Western populations.


Suzuki Y, Kaneko H, Okada A, et al. Change in cardiovascular health metrics and risk for proteinuria development: analysis of a nationwide population-based database. Am J Nephrol. Published online March 8, 2022. doi:10.1159/000522147

Suzuki Y, Kaneko H, Okada A, et al. Impact of glucose tolerance and its change on incident proteinuria: analysis of a nationwide population-based dataset. Am J Nephrol. Published online March 9, 2022. doi:10.1159/000522280