Serum Bicarbonate Is Associated with Heart Failure in the Multi-Ethnic Study of Atherosclerosis

Am J Nephrol. 2017;45(2):118-126. doi: 10.1159/000454783. Epub 2016 Dec 10.

Abstract

Background: Low serum bicarbonate concentrations are associated with mortality and kidney disease progression. Data regarding associations between bicarbonate and cardiovascular disease (CVD) are scarce.

Methods: We performed a cohort study of 6,229 adult participants from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort free of CVD at baseline. Serum bicarbonate was measured at baseline. Cardiovascular outcomes were defined as: (1) subclinical CVD (left ventricular mass [LVM] and aortic pulse pressure [PP] measured at baseline), (2) incident atherosclerotic cardiovascular events (CVE; composite of myocardial infarction, resuscitated cardiac arrest, stroke, coronary heart disease death, and stroke death), and (3) incident heart failure.

Results: During a median (interquartile range) follow-up of 8.5 (7.7-8.6) years, 331 (5.3%) participants had an incident CVE and 174 (2.8%) developed incident heart failure. We stratified analyses by use of diuretics because we observed a significant interaction between diuretic use and bicarbonate with study outcomes. Among diuretic nonusers, with adjustment, bicarbonate ≥25 mEq/L was associated with an estimated 3.0 g greater LVM (95% CI 0.5-5.0) and 1.0 mm Hg higher aortic PP (95% CI 0.4-2.0) compared to bicarbonate 23-24 mEq/L. Each 1 mEq/L of bicarbonate increase was associated with a 13% higher risk of incident heart failure (hazards ratio 1.13, 95% CI 1.01-2.11). Among diuretic users, higher bicarbonate was not associated with CVD. Bicarbonate was not associated with incident atherosclerotic CVE irrespective of diuretic use.

Conclusion: Among nonusers of diuretics in a large community-based study, higher serum bicarbonate concentrations are associated with subclinical CVD and new heart failure.

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Atherosclerosis / blood
  • Atherosclerosis / complications*
  • Atherosclerosis / ethnology
  • Bicarbonates / blood*
  • Blood Pressure
  • Creatinine / blood
  • Diuretics / therapeutic use
  • Ethnic Groups
  • Female
  • Follow-Up Studies
  • Heart Arrest / blood*
  • Heart Arrest / epidemiology
  • Heart Arrest / etiology
  • Heart Failure / blood*
  • Heart Failure / epidemiology
  • Heart Failure / etiology
  • Humans
  • Hypertension / drug therapy
  • Male
  • Middle Aged
  • Myocardial Infarction / blood*
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / etiology
  • Proportional Hazards Models
  • Prospective Studies
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications
  • Risk Factors
  • Stroke / blood*
  • Stroke / epidemiology
  • Stroke / etiology

Substances

  • Antihypertensive Agents
  • Bicarbonates
  • Diuretics
  • Creatinine