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CLINICAL RESEARCH: RISK FOR CARDIOVASCULAR DISEASE

Cardiovascular Risk Among Adults With Chronic Kidney Disease, With or Without Prior Myocardial Infarction

Keattiyoat Wattanakit, MD, MPH^_*, Josef Coresh, MD, PhD, Paul Muntner, PhD, Jane Marsh, PhD and Aaron R. Folsom, MD, MPH^_*,_*

^_* Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
Welch Center for Prevention, Epidemiology, and Clinical Research and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.

Manuscript received December 14, 2005; revised manuscript received May 1, 2006, accepted May 16, 2006.

^_* Reprint requests and correspondence: Dr. Aaron R. Folsom, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, Minnesota 55454-1015. (Email: folsom{at}epi.umn.edu).

OBJECTIVES: This study sought to determine whether chronic kidney disease (CKD) should be considered a coronary heart disease (CHD) risk equivalent for cholesterol treatment.

BACKGROUND: It is unclear whether patients with CKD have a risk of CHD events or cardiovascular disease (CVD) mortality equivalent to patients with a prior myocardial infarction (MI).

METHODS: Using data from the ARIC (Atherosclerosis Risk in Communities) study, we categorized nondiabetic participants based on their average level of kidney function (estimated glomerular filtration rate 60 or 30 to 59 ml/min/1.73 m², which defines stage 3 CKD) and on prior MI (yes or no). Rates and relative risks (RR) of CHD (MI or fatal CHD) events (n = 653) and CVD mortality (n = 209) that occurred over 10 years were compared across these populations.

RESULTS: Among 12,243 middle-age participants, 271 had stage 3 CKD. After adjustment for age, gender, race, and center, CHD incidence and CVD mortality rates per 1,000 person-years by presence of CKD and MI were 4.1 and 1.0 in the presence of neither condition, 8.0 and 3.4 in CKD only, 18.8 and 7.0 in MI only, and 30.8 and 18.0 in CKD and MI. After further adjustment for CVD risk factors, RR of CHD and CVD mortality were statistically significantly lower in subjects with CKD and no prior MI (RR = 0.44 [95% confidence interval (CI) 0.28 to 0.72] for CHD and RR = 0.46 [95% CI 0.24 to 0.90] for CVD mortality) than for subjects with no CKD and a prior MI.

CONCLUSIONS: Stage 3 CKD confers CHD risk that is lower and not equivalent to a prior MI in this middle-aged, general, nondiabetic population.

Abbreviations and Acronyms   ARIC = Atherosclerosis Risk in Communities study   CHD = coronary heart disease   CI = confidence interval   CKD = chronic kidney disease   CVD = cardiovascular disease   eGFR = estimated glomerular filtration rate   IMT = intima-media thickness   LDL = low-density lipoprotein   MI = myocardial infarction   NCEP ATP-III = National Cholesterol Education Program Adult Treatment Panel-III   RR = relative risk

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