Two‐Year Changes in Proteinuria and the Risk of Stroke in the Chinese Population: A Prospective Cohort Study

BACKGROUND Whether changes in proteinuria are associated with incident stroke in the general population is unclear. This study aimed to investigate the association between changes in proteinuria and incident stroke and its subtypes. METHODS AND RESULTS The current study included 60 940 Chinese participants (mean age, 50.69 years) who were free of stroke at the time of surveys (2006-2007 and 2008-2009). Participants were divided into 4 categories according to 2-year changes in proteinuria: no proteinuria, remittent proteinuria, incident proteinuria, and persistent proteinuria. Cox proportional hazards models were used to calculate hazard ratios and their 95% CIs for stroke. After a median follow-up period of 6.92 years, 1769 individuals developed stroke. After adjustment for confounding factors, incident proteinuria and persistent proteinuria were associated with increased risk of stroke (hazard ratio, 1.46 [95% CI, 1.26-1.68] and hazard ratio, 1.71 [95% CI, 1.42-2.06], respectively) compared with no proteinuria, which were higher than proteinuria detected at one single point (hazard ratio, 1.25; 95% CI, 1.09-1.43). The effect size for risk of stroke subtypes including ischemic stroke and hemorrhagic stroke was similar. CONCLUSIONS Changes in proteinuria exposure, particularly persistent proteinuria, are more likely to reflect the risk of stroke, compared with proteinuria collected at a single time point in the general population.