Urine albumin excretion and the risk of incident atrial fibrillation: predictive or aetiological relevance —Authors' reply

We appreciate the continuing interest of Abbasi1 in the PREVEND cohort. Our article showed that in a community-based cohort increased albumin excretion, and not estimated glomerular filtration rate, was associated with incident AF, even after adjustments for established cardiovascular risk factors.2 We agree that we cannot rule out unmeasured confounding or reverse causality. Theoretically, a randomized controlled trial or Mendelian randomization may be approaches to provide more causal evidence.3 However, the Mendelian randomization as brought forward based on GWAS variants are also not immune against unmeasured confounding or reverse causality, simply because the instrumental variable assumptions are not satisfied here (e.g. supported by strong biological understanding). To our knowledge, there is no therapy available that solely targets microalbuminuria that can be investigated to reduce incident AF. In addition, even when such therapies become available a large sample size will be required to perform a randomized trial in the primary prevention setting.
Source: Europace - Category: Cardiology Source Type: research