scholarly journals Association of Mildly Reduced Kidney Function With Cardiovascular Disease: The Framingham Heart Study

2021 ◽  
Author(s):  
Feven Ataklte ◽  
Rebecca J. Song ◽  
Ashish Upadhyay ◽  
Ibrahim Musa Yola ◽  
Ramachandran S. Vasan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Coronary Artery Calcium ◽  
Cox Regression ◽  
Disease Incidence ◽  
Subclinical Atherosclerosis ◽  
Calcium Score ◽  
Left Ventricular

Background Data are limited on the association of mildly reduced estimated glomerular filtration rate (eGFR 60–89 mL/min per 1.73 m 2 ) with cardiovascular disease (CVD) in the community. Methods and Results We evaluated 3066 Framingham Offspring Study participants (55% women, mean age 58 years), without clinical CVD. Using multivariable regression, we related categories of mildly reduced eGFR (80–89, 70–79, or 60–69 versus ≥90 mL/min per 1.73 m 2 [referent]) to prevalent coronary artery calcium, carotid intima media thickness, and left ventricular hypertrophy, and to circulating concentrations of cardiac stress biomarkers. We related eGFR categories to CVD incidence and to progression to ≥Stage 3 chronic kidney disease (eGFR <60 mL/min per 1.73 m 2 ) using Cox regression. Individuals with eGFR 60–69 mL/min per 1.73 m 2 (n=320) had higher coronary artery calcium score (odds ratio 1.69; 95% CI 1.02–2.80) compared with the referent group. Individuals with eGFR 60–69 and 70–79 mL/min per 1.73 m 2 had higher blood growth differentiating factor‐15 concentrations (β=0.131 and 0.058 per unit‐increase in log‐biomarker, respectively). Participants with eGFR 60–69 and 80–89 mL/min per 1.73 m 2 had higher blood B‐type natriuretic peptide concentrations (β=0.119 and 0.116, respectively). On follow‐up (median 16 years; 691 incident CVD and 252 chronic kidney disease events), individuals with eGFR 60–69 and 70–79 mL/min per 1.73 m 2 experienced higher CVD incidence (hazard ratio [HR], 1.40; 95% CI, 1.02–1.93 and 1.45, 95% CI, 1.05–2.00, respectively, versus referent). Participants with eGFR 60–69 mL/min per 1.73 m 2 experienced higher chronic kidney disease incidence (HR, 2.94; 95% CI, 1.80–4.78 versus referent). Conclusions Individuals with mildly reduced eGFR 60–69 mL/min per 1.73 m 2 have a higher burden of subclinical atherosclerosis cross‐sectionally, and a greater risk of CVD and chronic kidney disease progression prospectively. Additional studies are warranted to confirm our findings.

Abstract 13418: Inter-relation of Parity and Coronary Artery Calcium With Cardiovascular Disease Events: The Multi-ethnic Study of Atherosclerosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kimberly Vu ◽  
Khoa Nguyen ◽  
Jonathan Evans ◽  
WENJUN FAN ◽  
Morgana Mongraw-chaffin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Cox Regression ◽  
Subclinical Atherosclerosis ◽  
Cvd Risk ◽  
Ethnic Study ◽  
Live Births ◽  
A Prospective Study

Introduction: Coronary artery calcium (CAC) is a measure of subclinical atherosclerosis and predicts cardiovascular disease (CVD) events. Greater parity, or number of live births, has been shown to relate to CVD. We examined whether the relation of parity to CVD events may depend on the presence and extent of subclinical atherosclerosis measured by CAC. Methods: We studied 3151 women free of CVD at baseline in the Multi-Ethnic Study of Atherosclerosis, a prospective study of CVD. Participants were stratified by parity categories of 0-1 (reference), 2-3, and ≥4 and by baseline CAC categories of 0, 1-99, and 100+. We compared the incidence of CVD (myocardial infarction, stroke, resuscitated cardiac arrest, and coronary heart disease deaths) per 1000 years based on parity across levels of CAC over 13 years. Cox regression determined the joint association of parity and CAC on the incidence of CVD. Results: Women with greater parity had a higher prevalence of any CAC and CAC≥100 (p<0.01); among those with CAC, parity related to greater mean CAC scores (175, 184, and 284, respectively) (p<0.01). Women with greater parity also had greater incident CVD (7.1%, 8.7%, and 11.3% for 0-1, 2-3, and ≥4 live births, respectively, p-trend =0.01) and extent of CAC directly related to the incidence of CVD within parity groups. However, the association of parity with CAC was attenuated after adjustment for age, race, income, smoking and other risk factors. Parity also directly related to the incidence of CVD within CAC categories ( Figure ); however, from Cox regression analyses, these relations were attenuated when adjusted for age, ethnicity and other risk factors. Conclusion: In unadjusted analyses, we show parity to be associated with the prevalence of any or significant CAC, extent of CAC among those with CAC>0, as well as the incidence of CVD events, overall and according to the presence and extent of CAC. However, the association of parity with CVD risk was attenuated after adjustment for other factors.

scholarly journals Classification of Chronic Kidney Disease Biomarkers to Predict Coronary Artery Calcium

2012 ◽  
Vol 36 (1) ◽  
pp. 26-35 ◽  
Author(s):  
Sterling McPherson ◽  
Celestina Barbosa-Leiker ◽  
Robert Short ◽  
Katherine R. Tuttle
Keyword(s):  
Chronic Kidney Disease ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Coronary Artery Calcium ◽  
Disease Biomarkers

Role of coronary artery calcium score in the primary prevention of cardiovascular disease

BMJ ◽  
2021 ◽  
pp. n776
Author(s):  
Khurram Nasir ◽  
Miguel Cainzos-Achirica
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Primary Prevention ◽  
Coronary Artery Calcium ◽  
Calcium Score ◽  
Coronary Plaque ◽  
Preventive Therapy ◽  
Atherosclerotic Cardiovascular Disease ◽  
International Studies

Abstract First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called “power of zero”), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.

scholarly journals SAT-LB96 Chronic Kidney Disease Incidence and Cardiorespiratory Fitness Association in Patients With Diabetes And/Or Hypertension

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Joseph Powell ◽  
Eric S Nylen ◽  
Jonathan Myers ◽  
Pamela Karasik ◽  
Hans Moore ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiorespiratory Fitness ◽  
Cox Regression ◽  
Disease Incidence ◽  
Metabolic Equivalents ◽  
Patients With Diabetes ◽  
Exercise Treadmill ◽  
Traditional Risk Factors

Abstract Introduction: Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are considered strong risk factors for developing chronic kidney disease (CKD). Increased cardiorespiratory fitness (CRF) is associated with lower CKD risk. However, the CRF-CKD association in patients with T2DM and/or HTN has not been assessed.Methods: We identified 9,751 patients (age 58.6 + 10.1 years) with T2DM (N=1,444) or HTN (n=5,031) or both (n=3,276) prior to a maximal standardized exercise treadmill test (ETT) and no evidence of ischemia as indicated by the ETT. We established four CRF categories based on age-adjusted peak metabolic equivalents (METs) achieved: Least-Fit (4.6±1.2 METs; n=2,231); Low-Fit Fit (6.4±1.1 METs; n=2,693); Moderate-Fit (8.0±1.0 METs; n=2,432); and High-Fit (10.8±2.1 METs; n=2,395). We performed multivariable Cox Regression analyses to access the risk of CKD according to fitness. The models were adjusted for age, body mass index (BMI), traditional risk factors and medications. Results: During the median follow-up of 12.4 years, 1,118 patients developed CKD, accounting for 9.1 events/ 1,000 person-years of observation. The association between CRF and CKD was inverse and graded. The risk of CKD was 21% lower (Hazard Ratio [HR] 0.79; 95% confidence interval [CI] 0.77-0.81). When CRF categories were considered, the CKD risk was 44% lower for Moderate-Fit patients (HR 0.56; 95% CI 0.48-0.67) and 80% lower for High-Fit (HR 0.20; 95% CI 0.15-0.25). Similar findings were noted in patients with both T2DM and HTN. Conclusions: We noted an inverse and dose-response association between CRF and CKD incidence. The risk was attenuated significantly beyond a mean peak MET level of 8.0±1.0, suggesting that moderate increases in exercise capacity confers favorable health benefits in patients at high risk of developing CKD.

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