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J Am Coll Cardiol, 2003; 41:1364-1372, doi:10.1016/S0735-1097(03)00163-3
© 2003 by the American College of Cardiology Foundation
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CLINICAL STUDY: CARDIAC ISSUES IN WOMEN AND THE ELDERLY

Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals

Linda F. Fried, MD, MPH*{dagger},*, Michael G. Shlipak, MD, MPH{ddagger}§, Casey Crump, MD, PhD||, Anthony J. Bleyer, MD, John S. Gottdiener, MD, FACC#, Richard A. Kronmal, PhD||, Lewis H. Kuller, MD, DrPH, FACC** and Anne B. Newman, MD, MPH**{dagger}{dagger}

* Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
{dagger} Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
{ddagger} Medicine Service, Veterans Affairs Medical Center, San Francisco, California, USA
§ Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
|| Department of Biostatistics, University of Washington, Seattle, Washington, USA
Section of Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
# Division of Cardiology, St. Francis Hospital, Roslyn, New York, USA
** Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
{dagger}{dagger} Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Manuscript received May 20, 2002; revised manuscript received December 4, 2002, accepted December 30, 2002.

* Reprint requests and correspondence: Dr. Linda F. Fried, VA Pittsburgh Healthcare System, 111F-U, University Drive C, Pittsburgh, Pennsylvania 15240, USA.
lff9+{at}pitt.edu

OBJECTIVES: This study was designed to evaluate the relationship between elevated creatinine levels and cardiovascular events.

BACKGROUND: End-stage renal disease is associated with high cardiovascular morbidity and mortality. The association of mild to moderate renal insufficiency with cardiovascular outcomes remains unclear.

METHODS: We analyzed data from the Cardiovascular Health Study, a prospective population-based study of subjects, aged >65 years, who had a serum creatinine measured at baseline (n = 5,808) and were followed for a median of 7.3 years. Proportional hazards models were used to examine the association of creatinine to all-cause mortality and incident cardiovascular mortality and morbidity. Renal insufficiency was defined as a creatinine level ≥1.5 mg/dl in men or ≥1.3 mg/dl in women.

RESULTS: An elevated creatinine level was present in 648 (11.2%) participants. Subjects with elevated creatinine had higher overall (76.7 vs. 29.5/1,000 years, p < 0.001) and cardiovascular (35.8 vs. 13.0/1,000 years, p < 0.001) mortality than those with normal creatinine levels. They were more likely to develop cardiovascular disease (54.0 vs. 31.8/1,000 years, p < 0.001), stroke (21.1 vs. 11.9/1,000 years, p < 0.001), congestive heart failure (38.7 vs. 17/1,000 years, p < 0.001), and symptomatic peripheral vascular disease (10.6 vs. 3.5/1,000 years, p < 0.001). After adjusting for cardiovascular risk factors and subclinical disease measures, elevated creatinine remained a significant predictor of all-cause and cardiovascular mortality, total cardiovascular disease (CVD), claudication, and congestive heart failure (CHF). A linear increase in risk was observed with increasing creatinine.

CONCLUSIONS: Elevated creatinine levels are common in older adults and are associated with increased risk of mortality, CVD, and CHF. The increased risk is apparent early in renal disease.

Abbreviations and Acronyms
  AAI
  ankle-arm index
  CHF
  congestive heart failure
  CHS
  Cardiovascular Health Study
  CI
  confidence interval
  CRP
  C-reactive protein
  CVD
  cardiovascular disease
  HDL
  high-density lipoprotein
  HR
  hazards ratio
  IMT
  intima-media thickness
  LDL
  low-density lipoprotein
  MI
  myocardial infarction




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