CLINICAL STUDY: CHRONIC CORONARY ATHEROSCLEROSIS
Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community
Guruprasad Manjunath, MD*,
Hocine Tighiouart, MS ,
Hassan Ibrahim, MD ,
Bonnie MacLeod, BS ,
Deeb N. Salem, MD ,
John L. Griffith, PhD ,
Josef Coresh, MD, PhD||,
Andrew S. Levey, MD* and
Mark J. Sarnak, MD*,*
* Division of Nephrology, Boston, Massachusetts, USA
Division of Clinical Care Research, Boston, Massachusetts, USA
Division of Cardiology, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
|| Johns Hopkins School of Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
Manuscript received June 21, 2002;
revised manuscript received September 12, 2002,
accepted September 26, 2002.
* Reprint requests and correspondence: Dr. Mark J. Sarnak, Box 391, New England Medical Center, 750 Washington Street, Boston, Massachusetts 02111, USA. msarnak{at}lifespan.org
OBJECTIVES: The goal of this study was to determine whether the level of kidney function is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) outcomes in the Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study of subjects aged 45 to 64 years.
BACKGROUND: The level of kidney function is now recognized as a risk factor for ASCVD outcomes in patients at high risk for ASCVD, but it remains unknown whether the level of kidney function is a risk factor for ASCVD outcomes in the community.
METHODS: Cox proportional-hazards regression was used to evaluate the association of glomerular filtration rate (GFR) with ASCVD after adjustment for the major ASCVD risk factors in 15,350 subjects. We searched for nonlinear relationships between GFR and ASCVD.
RESULTS: During a mean follow-up time of 6.2 years, 965 (6.3%) of subjects had ASCVD events. Subjects with GFR of 15 to 59 ml/min/1.73 m2 (n = 444, hazard ratio 1.38 [1.02, 1.87]) and 60 to 89 ml/min/1.73 m2 (n = 7,665, hazard ratio 1.16 [1.00, 1.34]) had an increased adjusted risk of ASCVD compared with subjects with GFR of 90 to 150 ml/min/1.73 m2. Each 10 ml/min/1.73 m2 lower GFR was associated with an adjusted hazard ratio of 1.05 (1.02, 1.09), 1.07 (1.01, 1.12), and 1.06 (0.99, 1.13) for ASCVD, de novo ASCVD, and recurrent ASCVD, respectively. A nonlinear model did not fit the data better than a linear model.
CONCLUSIONS: The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study.
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Abbreviations and Acronyms
| | ARIC | | Atherosclerosis Risk in Communities Study | | ASCVD | | atherosclerotic cardiovascular disease | | CHD | | coronary heart disease | | CVD | | cardiovascular disease | | GFR | | glomerular filtration rate | | HDL | | high-density lipoprotein | | K/DOQI | | Kidney Disease Outcomes Quality Initiative | | LDL | | low-density lipoprotein | | LVH | | left ventricular hypertrophy | | MDRD | | Modification of Diet in Renal Disease | | NHANES | | National Health and Nutrition Examination Survey | | NKF | | National Kidney Foundation |
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Glycemic Status and Development of Kidney Disease: The Framingham Heart Study
Diabetes Care,
October 1, 2005;
28(10):
2436 - 2440.
[Abstract]
[Full Text]
[PDF]
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S. Nathan, C. J. Pepine, and G. L. Bakris
Calcium Antagonists: Effects on Cardio-Renal Risk in Hypertensive Patients
Hypertension,
October 1, 2005;
46(4):
637 - 642.
[Abstract]
[Full Text]
[PDF]
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O. Viktorsdottir, R. Palsson, M. B. Andresdottir, T. Aspelund, V. Gudnason, and O. S. Indridason
Prevalence of chronic kidney disease based on estimated glomerular filtration rate and proteinuria in Icelandic adults
Nephrol. Dial. Transplant.,
September 1, 2005;
20(9):
1799 - 1807.
[Abstract]
[Full Text]
[PDF]
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B. Pitt
Revascularization in patients with chronic kidney disease: the state of the ARTS
Eur. Heart J.,
August 1, 2005;
26(15):
1456 - 1457.
[Full Text]
[PDF]
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K. P. Klausen, H. Scharling, G. Jensen, and J. S. Jensen
New Definition of Microalbuminuria in Hypertensive Subjects: Association With Incident Coronary Heart Disease and Death
Hypertension,
July 1, 2005;
46(1):
33 - 37.
[Abstract]
[Full Text]
[PDF]
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R. Vanholder, Z. Massy, A. Argiles, G. Spasovski, F. Verbeke, N. Lameire, and for the European Uremic Toxin Work Group (EUTox)
Chronic kidney disease as cause of cardiovascular morbidity and mortality
Nephrol. Dial. Transplant.,
June 1, 2005;
20(6):
1048 - 1056.
[Abstract]
[Full Text]
[PDF]
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L. A. Stevens and A. S. Levey
Chronic Kidney Disease in the Elderly -- How to Assess Risk
N. Engl. J. Med.,
May 19, 2005;
352(20):
2122 - 2124.
[Full Text]
[PDF]
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M. J. Sarnak, R. Katz, C. O. Stehman-Breen, L. F. Fried, N. S. Jenny, B. M. Psaty, A. B. Newman, D. Siscovick, M. G. Shlipak, and and the Cardiovascular Health Study*
Cystatin C Concentration as a Risk Factor for Heart Failure in Older Adults
Ann Intern Med,
April 5, 2005;
142(7):
497 - 505.
[Abstract]
[Full Text]
[PDF]
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R. N. Foley, A. M. Murray, S. Li, C. A. Herzog, A. M. McBean, P. W. Eggers, and A. J. Collins
Chronic Kidney Disease and the Risk for Cardiovascular Disease, Renal Replacement, and Death in the United States Medicare Population, 1998 to 1999
J. Am. Soc. Nephrol.,
February 1, 2005;
16(2):
489 - 495.
[Abstract]
[Full Text]
[PDF]
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P. Muntner, J. He, B. C. Astor, A. R. Folsom, and J. Coresh
Traditional and Nontraditional Risk Factors Predict Coronary Heart Disease in Chronic Kidney Disease: Results from the Atherosclerosis Risk in Communities Study
J. Am. Soc. Nephrol.,
February 1, 2005;
16(2):
529 - 538.
[Abstract]
[Full Text]
[PDF]
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L. G. Bongartz, M. J. Cramer, P. A. Doevendans, J. A. Joles, and B. Braam
The severe cardiorenal syndrome: 'Guyton revisited'
Eur. Heart J.,
January 1, 2005;
26(1):
11 - 17.
[Abstract]
[Full Text]
[PDF]
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M. P. Tokmakova, H. Skali, S. Kenchaiah, E. Braunwald, J. L. Rouleau, M. Packer, G. M. Chertow, L. A. Moye, M. A. Pfeffer, and S. D. Solomon
Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial Infarction: The Survival And Ventricular Enlargement (SAVE) Study
Circulation,
December 14, 2004;
110(24):
3667 - 3673.
[Abstract]
[Full Text]
[PDF]
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S. J. Cameron and G. B. Green
Cardiac Biomarkers in Renal Disease: The Fog Is Slowly Lifting
Clin. Chem.,
December 1, 2004;
50(12):
2233 - 2235.
[Full Text]
[PDF]
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C. M. Gibson, R. L. Dumaine, E. V. Gelfand, S. A. Murphy, D. A. Morrow, S. D. Wiviott, R. P. Giugliano, C. P. Cannon, E. M. Antman, E. Braunwald, et al.
Association of glomerular filtration rate on presentation with subsequent mortality in non-ST-segment elevation acute coronary syndrome; observations in 13307 patients in five TIMI trials
Eur. Heart J.,
November 2, 2004;
25(22):
1998 - 2005.
[Abstract]
[Full Text]
[PDF]
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R. Mehran, E. D. Aymong, E. Nikolsky, Z. Lasic, I. Iakovou, M. Fahy, G. S. Mintz, A. J. Lansky, J. W. Moses, G. W. Stone, et al.
A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: Development and initial validation
J. Am. Coll. Cardiol.,
October 6, 2004;
44(7):
1393 - 1399.
[Abstract]
[Full Text]
[PDF]
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N. S. Anavekar, J. J.V. McMurray, E. J. Velazquez, S. D. Solomon, L. Kober, J.-L. Rouleau, H. D. White, R. Nordlander, A. Maggioni, K. Dickstein, et al.
Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction
N. Engl. J. Med.,
September 23, 2004;
351(13):
1285 - 1295.
[Abstract]
[Full Text]
[PDF]
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A. S. Go, G. M. Chertow, D. Fan, C. E. McCulloch, and C.-y. Hsu
Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and Hospitalization
N. Engl. J. Med.,
September 23, 2004;
351(13):
1296 - 1305.
[Abstract]
[Full Text]
[PDF]
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K. Klausen, K. Borch-Johnsen, B. Feldt-Rasmussen, G. Jensen, P. Clausen, H. Scharling, M. Appleyard, and J. S. Jensen
Very Low Levels of Microalbuminuria Are Associated With Increased Risk of Coronary Heart Disease and Death Independently of Renal Function, Hypertension, and Diabetes
Circulation,
July 6, 2004;
110(1):
32 - 35.
[Abstract]
[Full Text]
[PDF]
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V. Franco, S. Oparil, and O. A. Carretero
Hypertensive Therapy: Part II
Circulation,
June 29, 2004;
109(25):
3081 - 3088.
[Full Text]
[PDF]
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J. Segura, C. Campo, P. Gil, C. Roldan, L. Vigil, J. L. Rodicio, and L. M. Ruilope
Development Of Chronic Kidney Disease and Cardiovascular Prognosis in Essential Hypertensive Patients
J. Am. Soc. Nephrol.,
June 1, 2004;
15(6):
1616 - 1622.
[Abstract]
[Full Text]
[PDF]
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D. E. Weiner, H. Tighiouart, M. G. Amin, P. C. Stark, B. MacLeod, J. L. Griffith, D. N. Salem, A. S. Levey, and M. J. Sarnak
Chronic Kidney Disease as a Risk Factor for Cardiovascular Disease and All-Cause Mortality: A Pooled Analysis of Community-Based Studies
J. Am. Soc. Nephrol.,
May 1, 2004;
15(5):
1307 - 1315.
[Abstract]
[Full Text]
[PDF]
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J. A. Joles and H. A. Koomans
Causes and Consequences of Increased Sympathetic Activity in Renal Disease
Hypertension,
April 1, 2004;
43(4):
699 - 706.
[Abstract]
[Full Text]
[PDF]
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F. A. McAlister, J. Ezekowitz, M. Tonelli, and P. W. Armstrong
Renal Insufficiency and Heart Failure: Prognostic and Therapeutic Implications From a Prospective Cohort Study
Circulation,
March 2, 2004;
109(8):
1004 - 1009.
[Abstract]
[Full Text]
[PDF]
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L. M. Ruilope
New European guidelines for management of hypertension: what is relevant for the nephrologist
Nephrol. Dial. Transplant.,
March 1, 2004;
19(3):
524 - 528.
[Full Text]
[PDF]
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T. Pinkau, K. F. Hilgers, R. Veelken, and J. F. E. Mann
How Does Minor Renal Dysfunction Influence Cardiovascular Risk and the Management of Cardiovascular Disease?
J. Am. Soc. Nephrol.,
March 1, 2004;
15(3):
517 - 523.
[Abstract]
[Full Text]
[PDF]
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C. S. Fox, M. G. Larson, E. P. Leip, B. Culleton, P. W. F. Wilson, and D. Levy
Predictors of New-Onset Kidney Disease in a Community-Based Population
JAMA,
February 18, 2004;
291(7):
844 - 850.
[Abstract]
[Full Text]
[PDF]
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J. Segura, C. Campo, C. Roldan, H. Christiansen, L. Vigil, R. Garcia-Robles, J. L. Rodicio, and L. M. Ruilope
Hypertensive Renal Damage in Metabolic Syndrome Is Associated with Glucose Metabolism Disturbances
J. Am. Soc. Nephrol.,
January 1, 2004;
15(90010):
S37 - 42.
[Abstract]
[Full Text]
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A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al.
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure
Hypertension,
December 1, 2003;
42(6):
1206 - 1252.
[Abstract]
[Full Text]
[PDF]
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H. Reinecke and R. M. Schaefer
Percutaneous coronary interventions in patients with mild to moderate chronic renal failure: to dilate or not to dilate?
Nephrol. Dial. Transplant.,
November 1, 2003;
18(11):
2218 - 2221.
[Full Text]
[PDF]
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