Relation of fibrinogen to cardiovascular events is independent of preclinical cardiovascular disease: The strong heart study

BACKGROUND Rapid kidney decline is associated with mortality and cardiovascular disease, even in the absence of chronic kidney disease. American Indians (AI) have particularly high burden of kidney disease, cardiovascular disease, and stroke. This study aims to examine extreme loss in glomerular function in this population in association with clinical outcomes. METHODS The Strong Heart Study, a large longitudinal cohort of adult AI participants, collected plasma creatinine at 3 examination visits between 1989-1999. Intraindividual regressions of estimated glomerular filtration rate (eGFR) provided linear estimates of change in kidney function over this time period. Surveillance with physician adjudication identified mortality and cardiovascular events between visit 3 through 2017. RESULTS Mean change in eGFR was loss 6.8 mL/min over the ten year baseline (range: -66.0 to +28.9 mL/min). The top 1 percentile lost approximately 5.7 mL/min/year. Participants with extreme eGFR loss were more likely to have diabetes (95% vs 71%), hypertension (49% vs 33%), or longer smoking history, among smokers (19 pack years vs 17 pack years). CKD (eGFR<60 mL/min) was associated only with mortality, independent of slope: HR 1.1 (95% CI 1.0-1.3). However, extreme loss in eGFR (>20 mL/min over baseline period) was associated with mortality, independent of baseline eGFR: HR 3.5 (95% CI 2.7-4.4), and also independently associated with composite CVD events and CHF: HR 1.4 and 1.7 (95% CI 1.1-1.9 and 1.2-2.6), respectively. CONCLUSION This is the first examination of decline in eGFR in association with mortality and CVD among AIs. The implications of these findings are broad: clinical evaluation may benefit from evaluating change in eGFR over time in addition to dichotomous eGFR. Also, these findings suggest there may be aspects of renal function that are not well-marked by clinical CKD, but which may have particular relevance to long-term renal and vascular health.

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Faculty Opinions recommendation of Prevalence and prognostic significance of wall-motion abnormalities in adults without clinically recognized cardiovascular disease: the Strong Heart Study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1089925.543019 ◽

2007 ◽

Author(s):

Raimund Erbel

Keyword(s):

Cardiovascular Disease ◽

Wall Motion ◽

Prognostic Significance ◽

Strong Heart Study ◽

Heart Study ◽

Wall Motion Abnormalities

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Blood-based DNA methylation biomarkers for cumulative lead exposure: associations with cardiovascular disease incidence and mortality in the Strong Heart Study

ISEE Conference Abstracts ◽

10.1289/isee.2020.virtual.o-os-131 ◽

2020 ◽

Vol 2020 (1) ◽

Author(s):

X. Gao ◽

A. Domingo-Relloso ◽

E. Colicino ◽

S. A. Cole ◽

K. Haack ◽

...

Keyword(s):

Cardiovascular Disease ◽

Dna Methylation ◽

Lead Exposure ◽

Disease Incidence ◽

Strong Heart Study ◽

Heart Study ◽

Incidence And Mortality ◽

Cardiovascular Disease Incidence

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Abstract P038: Cadmium Exposure is Prospectively Associated to Cardiovascular Risk in the Strong Heart Study

Circulation ◽

10.1161/circ.125.suppl_10.ap038 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Maria Tellez-Plaza ◽

Eliseo Guallar ◽

Barbara Howard ◽

Jason Umans ◽

Kevin Francesconi ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Cardiovascular Risk ◽

Cardiovascular Events ◽

Cadmium Exposure ◽

Cardiovascular Disease Mortality ◽

Hazard Ratios ◽

Disease Mortality ◽

Heart Study ◽

Urine Cadmium

Introduction: Cadmium is a widespread toxic metal with potential cardiovascular effects, but establishing cadmium as a cardiovascular risk factor has been limited by the lack of data on its association with incident cardiovascular events. Hypothesis: We tested the hypothesis that urine cadmium concentrations would be associated with cardiovascular disease mortality and incidence. Methods: Prospective cohort study of 3,347 American Indian adults 45-74 years old without prevalent cardiovascular disease from Arizona, Oklahoma and North and South Dakota who participated in the Strong Heart Study (SHS) in 1989-91 and had urine cadmium measures available. Urine cadmium was measured using inductively coupled plasma mass spectrometry. Follow-up extended through December 30 th 2007. Results: We identified 1,028 cardiovascular events, including 372 deaths. After adjustment for known cardiovascular risk factors, the hazard ratios (95% CI) for cardiovascular and coronary heart disease mortality, comparing the 80 th to the 20 th percentiles of urine cadmium concentrations, were 1.43 (1.21, 1.69) and 1.33 (1.09, 1.62), respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, stroke, and heart failure were 1.16 (1.04, 1.29), 1.11 (0.98, 1.27), 1.50 (1.01, 2.22) and 1.22 (1.01, 1.47), respectively. The associations were similar in different study subgroups, including never-smokers. The figure shows increasing dose-response relations between urine cadmium concentrations and all cardiovascular disease mortality and incidence endpoints except for incident stroke. Conclusions: Urine cadmium, a biomarker of long-term exposure, was positively and consistently associated with cardiovascular disease mortality and incidence, overall and across subgroups. These findings support that cadmium exposure is a cardiovascular risk factor irrespective of the source of exposure. Efforts to reduce cadmium exposure in the population are needed.

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