Weight Change and Development of Subclinical Carotid Atherosclerosis Among Metabolically Healthy Adults: A Cohort Study

Abstract Background The benefit of weight loss for reducing cardiovascular disease (CVD) risk in metabolically healthy obese people is unknown. Objectives We evaluated the association between weight change and incident subclinical carotid atherosclerosis (SCA) in metabolically healthy but overweight or obese subjects. Methods Cohort study of 3117 metabolically healthy overweight or obese adults who did not have any metabolic syndrome components or insulin resistance at baseline. SCA was assessed using carotid artery ultrasonography. The study outcome was the development of incident SCA among participants free of the disease at baseline. Results During 12 248 person-years of follow-up (median 3.42 years), 747 participants developed SCA. The proportions of participants with no reduction or increased weight, reduction in weight from 0.1% to 4.9%, and reduction in weight ≥ 5% during follow-up were 47.0%, 44.4%, and 8.6%, respectively. The fully-adjusted hazard ratios (HRs) for incident SCA in participants with a reduction in weight of 0.1% to 4.9% and ≥ 5% compared with those with no reduction or increased weight were 0.84 (95% CI, 0.72–0.98) and 0.66 (95% CI, 0.50–0.87), respectively. Conclusions In a large cohort study of metabolically healthy but overweight or obese adult men and women, weight reduction was associated with a lower incidence of SCA. Our findings suggest that metabolically healthy overweight or obese subjects may benefit from weight reduction in terms of CVD risk.

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Natural Course of Metabolically Healthy Overweight/Obese Subjects and the Impact of Weight Change

Nutrients ◽

10.3390/nu8070430 ◽

2016 ◽

Vol 8 (7) ◽

pp. 430 ◽

Cited By ~ 8

Author(s):

Ruizhi Zheng ◽

Chengguo Liu ◽

Chunmei Wang ◽

Biao Zhou ◽

Yi Liu ◽

...

Keyword(s):

Weight Change ◽

Natural Course ◽

Obese Subjects ◽

Metabolically Healthy ◽

The Impact

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Abstract 44: Cardiometabolic Responses to Weight Change are Different between Obese and Normal Weight Adults Who are Metabolically Healthy: The Atherosclerosis Risk in Communities Study

Circulation ◽

10.1161/circ.131.suppl_1.44 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Zhaohui Cui ◽

Kimberly P Truesdale ◽

Patrick T Bradshaw ◽

Jianwen Cai ◽

June Stevens

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Weight Loss ◽

Weight Gain ◽

Weight Change ◽

Weight Maintenance ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Obese Adults ◽

Metabolically Healthy

Introduction: The 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults recommended weight loss for obese adults in order to reduce their cardiovascular disease (CVD) risk. However, not all obese adults develop CVD and approximately 17% of obese Americans in the 1999-2004 NHANES were metabolically healthy. The absence of abnormal CVD risk factors in this subgroup of obese adults indicates that some individuals are resistant to excess adiposity and positive energy balance, and raises the question of whether all obese adults should be recommended for weight loss treatment. We know of no study that has examined whether metabolically healthy obese (MHO) adults respond to weight changes the same way as metabolically healthy normal weight adults (MHNW). Also, no study has compared the effects of weight loss, weight maintenance and weight gain on CVD risk factors in MHO adults. Hypothesis: We hypothesized that the effects of weight change would be different in MHNW and MHO adults, with MHO adults having less stable risk factors, and that weight loss has a protective effect on CVD risk factors in the MHO compared to weight maintenance and weight gain. Methods: Data were from 2,710 MHO and MHNW participants in the Atherosclerosis Risk in Communities (ARIC) study. Four examinations yielded 4,541 observations over sequential 3-year intervals. Metabolically healthy was defined as absence of all components of metabolic syndrome, excluding waist circumference, at the beginning of a 3-year interval. Mixed effect models were applied to individually compare changes in five CVD risk factors (systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol and glucose) in MHO and MHNW adults within 3 weight change categories (<3% weight loss, weight maintenance (±3%) and >3% weight gain). Results: Weight loss was associated with small or no changes in the five CVD risk factors in both MHO and MHNW adults. Weight maintenance was associated with larger increases in MHO compared to MHNW adults in triglycerides (mean ± standard error: 10.0±1.7 vs. 6.5±1.0 mg/dL) and glucose (1.7±0.4 vs. 0.9±0.2 mg/dL). Weight gain was associated with larger increases in systolic (8.6±0.6 vs. 6.2±0.4 mmHg) and diastolic (3.9±0.4 vs. 2.5±0.3 mmHg) blood pressure, triglycerides (22.0±1.8 vs. 16.0±1.1 mg/dL) and glucose (4.9±0.4 vs. 1.9±0.3 mg/dL) among the MHO compared to the MHNW. MHO weight losers experienced more favorable changes in the five CVD risk factors compared to MHO weight maintainers (p<0.04) or gainers (p<0.0001). Conclusions: We showed that compared to MHNW, MHO adults experienced similar changes in CVD risk factors with weight loss and larger increases with weight maintenance and gain. Our study supports the 2013 Guideline that primary health care providers should recommend weight loss treatment for MHO patients.

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Risk factors for cardiovascular disease in rural South India: cohort study

BMJ Open ◽

10.1136/bmjopen-2019-029759 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029759 ◽

Cited By ~ 1

Author(s):

Prabhdeep Kaur ◽

Sudha Ramachandra Rao ◽

Ramachandran Venkatachalam ◽

Boopathi Kangusamy ◽

Ezhil Radhakrishnan ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Outcome Measures ◽

Central Obesity ◽

Tamil Nadu ◽

South India ◽

Population Attributable Fraction ◽

Cerebrovascular Event ◽

Cvd Risk

Background and objectivesCardiovascular diseases (CVD) accounted for one-third of the deaths in India. We conducted a cohort study to estimate the incidence of CVD and the association of established risk factors with the incident CVD in a rural population in South India.Design, setting and participantsWe conducted a community-based cohort study among 6026 adults aged 25–64 years in five villages in Tiruvallur, Tamil Nadu. We did baseline (2005–2007) and two follow-up surveys in 2008–2009 and 2013–2015. Risk factors studied were tobacco, alcohol, hypertension, self-reported diabetes and central obesity.Outcome measuresOutcome measures were fatal or non-fatal ischaemic heart disease or cerebrovascular event. We estimated HRs for the risk factors and population attributable fraction (PAF).ResultsWe followed up 5641 (94.4%) subjects, and follow-up duration was 33 371 person years. The overall incidence of cardiovascular event or death was 4.6 per 1000 person years. Current smoking (HR 1.6, 95% CI 1.1 to 2.6) and hypertension (HR 2.2, 95% CI 1.5 to 3.4) were the risk factors among men and accounted for 47% of the PAF. Among women, hypertension (HR 1.8, 95% CI 1.0 to 3.4), self-reported diabetes (HR 4.3, 95% CI 2.2 to 8.1) and central obesity (HR 2.2, 95% CI 1.2 to 4.0) were associated with CVD and accounted for more than half of the PAF.ConclusionsWe described the high burden of fatal CVD and identified the role of CVD risk factors such as hypertension, self-reported diabetes, smoking and central obesity. There is an urgent need to implement low-cost interventions such as smoking cessation and treat hypertension and diabetes in primary care settings.

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Weight change over two years in people prescribed olanzapine, quetiapine and risperidone in UK primary care: Cohort study in THIN, a UK primary care database

Journal of Psychopharmacology ◽

10.1177/0269881118780011 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1098-1103 ◽

Cited By ~ 3

Author(s):

David PJ Osborn ◽

Irene Petersen ◽

Nick Beckley ◽

Kate Walters ◽

Irwin Nazareth ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Weight Gain ◽

Confidence Interval ◽

Weight Change ◽

Antipsychotic Treatment ◽

Weight Changes ◽

Baseline Weight ◽

Care Database

Background: Follow-up studies of weight gain related to antipsychotic treatment beyond a year are limited in number. We compared weight change in the three most commonly prescribed antipsychotics in a representative UK General Practice database. Method: We conducted a cohort study in United Kingdom primary care records of people newly prescribed olanzapine, quetiapine or risperidone. The primary outcome was weight in each six month period for two years after treatment initiation. Weight changes were compared using linear regression, adjusted for age, baseline weight and diagnosis. Results: N = 6338 people received olanzapine, 12,984 quetiapine and 6556 risperidone. Baseline weight was lowest for men treated with olanzapine (80.8 kg versus 83.5 kg quetiapine, 82.0 kg risperidone) and women treated with olanzapine (67.7 kg versus 71.5 kg quetiapine 68.4 kg risperidone. Weight gain occurred during treatment with all three drugs. Compared with risperidone mean weight gain was higher with olanzapine (adjusted co-efficient +1.24 kg (95% confidence interval: 0.69–1.79 kg per six months) for men and +0.77 kg (95% confidence interval: 0.29–1.24 kg) for women). Weight gain with quetiapine was lower in unadjusted models compared with risperidone, but this difference was not significant after adjustment. Conclusion: Olanzapine is more commonly prescribed to people with lower weight. However, after accounting for baseline weight, age, sex and diagnosis, olanzapine is still associated with greater weight gain over two years than risperidone or quetiapine. Baseline weight does not ameliorate the risks of weight gain associated with antipsychotic medication. Weight gain should be assertively discussed and managed for people prescribed antipsychotics, especially olanzapine.

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Vitamin D intake and risk of CVD and all-cause mortality: evidence from the Caerphilly Prospective Cohort Study

Public Health Nutrition ◽

10.1017/s1368980017001732 ◽

2017 ◽

Vol 20 (15) ◽

pp. 2744-2753 ◽

Cited By ~ 4

Author(s):

Jing Guo ◽

John R Cockcroft ◽

Peter C Elwood ◽

Janet E Pickering ◽

Julie A Lovegrove ◽

...

Keyword(s):

Blood Pressure ◽

Vitamin D ◽

Cohort Study ◽

Diastolic Blood Pressure ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cvd Risk ◽

Vitamin D Intake ◽

All Cause Mortality

AbstractObjectiveProspective data on the associations between vitamin D intake and risk of CVD and all-cause mortality are limited and inconclusive. The aim of the present study was to investigate the associations between vitamin D intake and CVD risk and all-cause mortality in the Caerphilly Prospective Cohort Study.DesignThe associations of vitamin D intake with CVD risk markers were examined cross-sectionally at baseline and longitudinally at 5-year, 10-year and >20-year follow-ups. In addition, the predictive value of vitamin D intake for CVD events and all-cause mortality after >20 years of follow-up was examined. Logistic regression and general linear regression were used for data analysis.SettingParticipants in the UK.SubjectsMen (n452) who were free from CVD and type 2 diabetes at recruitment.ResultsHigher vitamin D intake was associated with increased HDL cholesterol (P=0·003) and pulse pressure (P=0·04) and decreased total cholesterol:HDL cholesterol (P=0·008) cross-sectionally at baseline, but the associations were lost during follow-up. Furthermore, higher vitamin D intake was associated with decreased concentration of plasma TAG at baseline (P=0·01) and at the 5-year (P=0·01), but not the 10-year examination. After >20 years of follow-up, vitamin D was not associated with stroke (n72), myocardial infarctions (n142), heart failure (n43) or all-cause mortality (n281), but was positively associated with increased diastolic blood pressure (P=0·03).ConclusionsThe study supports associations of higher vitamin D intake with lower fasting plasma TAG and higher diastolic blood pressure.

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P5295Stable and temporal metabolically benign obesity and cardiovascular disease onset in males and females: the missing link with adiponectin

European Heart Journal ◽

10.1093/eurheartj/ehz746.0266 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Kouvari ◽

D B Panagiotakos ◽

M Yannakoulia ◽

C Chrysohoou ◽

E Georgousopoulou ◽

...

Keyword(s):

Adiponectin Level ◽

Mean Value ◽

Mediating Effect ◽

Metabolic Status ◽

Considerable Proportion ◽

Cvd Risk ◽

Metabolically Healthy ◽

The Mean ◽

The Stability

Abstract Background/Introduction Metabolically healthy obesity (MHO) status has been recently conferred to be a transient condition with cohorts revealing that a considerable proportion, from 33% to 52%, lose their status over time. Purpose To evaluate the stability of MHO, its effect on 10-year first fatal/non fatal CVD onset and the mediating effect of adiponectin. Methods A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants; of them, n=317 incident cases were identified. Obesity was defined as body mass index≥30kg/m2 and healthy metabolic status as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Circulating adiponectin level was measured at baseline (4.0 (2.0) μg/mL). Results MHO prevalence reached 4.8% (n=146) (4.9% in males and 4.7% in females, p=0.198). 28.2% of obese participants presented a metabolically benign status at baseline. In the 5-year follow-up period, transition to metabolically unhealthy status was observed for 33% of MHO participants. Within the decade, almost half of MHO participants resulted as metabolically unhealthy obese. Unadjusted analysis revealed that stable vs. temporal MHO subjects had better lifestyle (i.e. higher adherence to Mediterranean diet and better physical activity status) at the recruitment (all ps<0.05). Temporal MHO subjects presented lower adiponectin values (2.8 (1.1) μg/mL) compared with their stable MHO counterparts (4.1 (1.9) μg/mL) (p<0.05). Multivariate Cox regression analysis revealed no significant discrepancies on 10-year CVD risk between MHO and metabolically healthy non-obese subjects (Hazard Ratio (HR)=0.95, 95% Confidence Interval (95% CI) 0.37, 2.08, p=0.32). Only the subset of temporal MHO subjects reached the level of significance (HR=1.43, 95% CI 1.02, 2.01, p=0.04). Stable MHO status was not independently associated with 10-year CVD risk (p>0.05). Low vs. high adiponectin level was associated with ∼1.3 times higher 10-year risk to move from MHO to metabolically unhealthy obesity status (HR=1.33 95% CI 1.10, 4.02). Sensitivity analyses revealed that adiponectin had a significant interacting effect on the examined associations (p for interaction=0.01); stratified analysis using the mean value of adiponectin to define the strata revealed that MHO (stable or temporal) status was positively associated with 10-year CVD event only in participants with low adiponectin levels i.e. below the mean value of 4.1 μg/mL (HR=1.45 95% CI 1.19, 3.68). Conclusions Weight management is needed to prevent cardiometabolic features even in participants with increased weight status with healthy metabolic status. It is noteworthy that adiponectin may be an underlying path of the stability and CVD risk corresponding to this intermediate condition probably related with insulin resistance and other relevant paths. Acknowledgement/Funding The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

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Abstract P256: Stability of Obesity and Metabolic Health and the Risk of Cardiovascular Disease

Circulation ◽

10.1161/circ.137.suppl_1.p256 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Todd Sponholtz ◽

Justin B Echouffo-Tcheugui ◽

Ramachandran S Vasan

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Cox Proportional Hazards ◽

Metabolic Health ◽

Lipid Lowering ◽

Cvd Risk ◽

High Blood Glucose ◽

Coronary Insufficiency ◽

Metabolically Healthy

Introduction: Metabolic syndrome (MetSyn) reportedly confers higher risk of cardiovascular disease (CVD) than its individual components. Although typically defined as a binary exposure, each of its component factors can vary over time. Little is known about whether CVD risk differs according to MetSyn stability. Methods: We defined longitudinal states of obesity and metabolic health among 2,952 Framingham Offspring Study participants for whom we had sufficient data to define MetSyn at ≥4 exams between Exams 2 (1979-1983) and 9 (2011-2014). Obesity was defined as BMI ≥30 kg/m 2 , high triglycerides as ≥150 mg/dL/taking lipid-lowering medication, low HDL as <40 mg/dL for males/ <50 mg/dL for females; high blood pressure as systolic blood pressure ≥130 mm Hg/diastolic blood pressure ≥85 mm Hg/taking antihypertensive medication, and high blood glucose as ≥100 mg/dL/taking antidiabetic medication. Metabolic health was defined as having <2 metabolic conditions. Obesity and metabolic health were classified as unstable if there was a change from one state to the other in ≥33% of observations occurring before a CVD event or end of follow-up, stable obese/metabolically unhealthy if not unstable and >50% of observations were classified as stable obese/metabolically unhealthy, or stable non-obese/metabolically healthy otherwise. CVD was defined as any of the following coronary death, myocardial infarction, coronary insufficiency, angina pectoris, stroke, transient ischemic attack, intermittent claudication, or congestive heart failure. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards regression with age as the time scale. Results: We classified 332 participants (11.3%) as having unstable metabolic health, and 130 (4.4%) as having unstable obesity. We observed 1,206 events in 75,673 person-years of follow-up (median 30 years). Participants classified as stable metabolically unhealthy had the highest CVD risk (HR 1.77, 95% CI 1.47, 2.13, compared to stable metabolically healthy). Stable obesity was associated with a 48% (95% CI 24, 80) increase in CVD risk relative to stable non-obese. Unstable metabolic health and obesity were associated with moderate increases in risk compared to stable metabolically healthy and stable non-obese (HRs: 1.32, 95% CI 1.03, 1.71 and 1.25, 95% CI 0.88, 1.77, respectively). There was no interaction between obesity- and metabolic health stability (p interaction =0.23). Conclusions: In our sample, stability of obesity and of metabolic health influenced CVD risk, with the highest risk of CVD observed among stable metabolically unhealthy participants. Instability of both obesity and metabolic health convey a risk intermediate between the stable obese/metabolically healthy and stable non-obese/metabolically unhealthy conditions.

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BMI, high-sensitivity C-reactive protein and the conversion from metabolically healthy to unhealthy phenotype in Chinese adults: a cohort study

Public Health Nutrition ◽

10.1017/s136898002000289x ◽

2020 ◽

pp. 1-8

Author(s):

Renying Xu ◽

Peixiao Shen ◽

Chunhua Wu ◽

Yanping Wan ◽

Zhuping Fan ◽

...

Keyword(s):

Cohort Study ◽

Serum Uric Acid Level ◽

Fasting Blood Glucose ◽

High Sensitivity ◽

C Reactive Protein ◽

Chinese Adults ◽

Reactive Protein ◽

Metabolically Healthy ◽

Hs Crp

Abstract Objective: We performed the cohort study to evaluate the association between BMI, high-sensitivity C-reactive protein (hs-CRP) and the conversion from metabolically healthy to unhealthy phenotype in Chinese adults. Design: Metabolically healthy was defined as participants without history of metabolic diseases and with normal fasting blood glucose level, glycated Hb A1c level, blood pressure, lipid profile, serum uric acid level and liver ultrasonographic findings at baseline. Participants were either classified into normal weight (18·5 ≤ BMI < 24·0 kg/m2) and overweight (BMI ≥ 24·0 kg/m2) based on baseline BMI, or low (<1 mg/l) and high (≥1 mg/l) groups based on baseline hs-CRP. The conversion from metabolically healthy to unhealthy phenotype was deemed if any of the metabolic abnormalities had been confirmed twice or more during 5 years of follow-up. Results: Included were 4855 (1942 men and 2913 women, aged 36·0 ± 8·9 years) metabolically healthy Chinese adults. We identified 1692 participants who converted to metabolically unhealthy phenotype during the follow-up. Compared with their counterparts, the adjusted hazards ratio of the conversion was 1·19 (95 % CI 1·07, 1·33) for participants with overweight, while it was 1·15 (95 % CI 1·03, 1·29) for those with high hs-CRP level (≥1 mg/l). Further adjustment of hs-CRP did not materially change the association between BMI and the conversion. However, the association between hs-CRP and the conversion was not significant after further adjustment of BMI. The sensitivity analysis generated similar results to main analysis. Conclusion: BMI was associated with the risk of the conversion from metabolically healthy to unhealthy status in Chinese adults.

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POS0213 20 Year Follow-Up Of Cardiovascular Event Risk In Rheumatoid Arthritis Compared To Diabetes

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1744 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 324.1-324

Author(s):

R. Raadsen ◽

R. Agca ◽

A. Voskuyl ◽

M. Boers ◽

W. Lems ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

At Risk ◽

Cohort Study ◽

General Population ◽

Incidence Rate ◽

Cardiovascular Event ◽

Survival Curve ◽

Cvd Risk ◽

Event Risk

Background:Patients with rheumatoid arthritis have an increased risk for developing cardiovascular diseases (CVD) compared to the general population, similar to the CVD risk in patients with diabetes mellitus. However, there are no controlled studies investigating the incidence of cardiovascular (CV) events in RA patients with follow up of more than 20 years.Objectives:The objectives of the current study were to investigate the incidence rates of CV events in a long-term follow up cohort of RA patients, and to compare these to a similar cohort representing the general population, ie. The Hoorn study.Methods:The CARRÉ study is an ongoing prospective cohort study, which started in 2001, investigating CV mortality and morbidity in 353 randomly selected patients with RA. Primary endpoints, i.e. verified medical history of coronary, cerebral or peripheral arterial disease, were determined at baseline, and after three, ten, fifteen and twenty years of follow up. Patients were censored at the date of an experienced CV event or their death. Incidence density rates per 100 patient years were calculated. Data were compared to results from the Hoorn study, a Dutch cohort study of glucose metabolism and other CV risk factors that began in 1989. All 2,484 participants were subject to an extensive and repeated CV screening program similar to that used in the CARRÉ study.Results:After 20 years of follow up 118 patients (33%) developed at least one CV event in the Carré group. Mean (SD) follow up time was 11 (6) years with a total of 3,500 years at risk and an incidence rate of 3.4 per 100 patient-years; this is slightly up from the figure reported at 15 years, i.e. 3.2 per 100 patient-years. A CV event-free survival curve is shown in figure 1. After 30 years of follow up, 295 participants of the Hoorn study had developed a CV event, during a mean follow up time 20 (8) years. Total time at risk was 50,000 years, with an incidence rate of 0.6 CV events per 100 patient years.Conclusion:In our cohort the incidence rate of CV events in RA patients has remained consistently high when compared with the general population, despite better control of RA inflammation in recent years. This again confirms the need for timely CVD-risk screening and management.References:[1]Agca R, Hopman L, Laan KJC, van Halm VP, Peters MJL, Smulders YM, et al. Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study. J Rheumatol. 2020;47(3):316-24.Figure 1.Survival curve of participants with rheumatoid arthritis. RA = rheumatoid arthritisDisclosure of Interests:None declared

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Nomogram to predict risk of incident chronic kidney disease in high-risk population of cardiovascular disease in China: community-based cohort study

BMJ Open ◽

10.1136/bmjopen-2020-047774 ◽

2021 ◽

Vol 11 (11) ◽

pp. e047774

Author(s):

Qiuxia Zhang ◽

Jingyi Zhang ◽

Li Lei ◽

Hongbin Liang ◽

Yun Li ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Cox Regression ◽

Validation Cohort ◽

High Risk Population ◽

Cvd Risk ◽

Incident Chronic Kidney Disease

AimsTo develop a nomogram for incident chronic kidney disease (CKD) risk evaluation among community residents with high cardiovascular disease (CVD) risk.MethodsIn this retrospective cohort study, 5730 non-CKD residents with high CVD risk participating the National Basic Public Health Service between January 2015 and December 2020 in Guangzhou were included. Endpoint was incident CKD defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 during the follow-up period. The entire cohorts were randomly (2:1) assigned to a development cohort and a validation cohort. Predictors of incident CKD were selected by multivariable Cox regression and stepwise approach. A nomogram based on these predictors was developed and evaluated with concordance index (C-index) and area under curve (AUC).ResultsDuring the median follow-up period of 4.22 years, the incidence of CKD was 19.09% (n=1094) in the entire cohort, 19.03% (727 patients) in the development cohort and 19.21% (367 patients) in the validation cohort. Age, body mass index, eGFR 60–89 mL/min/1.73 m2, diabetes and hypertension were selected as predictors. The nomogram demonstrated a good discriminative power with C-index of 0.778 and 0.785 in the development and validation cohort. The 3-year, 4-year and 5-year AUCs were 0.817, 0.814 and 0.834 in the development cohort, and 0.830, 0.847 and 0.839 in the validation cohort.ConclusionOur nomogram based on five readily available predictors is a reliable tool to identify high-CVD risk patients at risk of incident CKD. This prediction model may help improving the healthcare strategies in primary care.

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