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(Circulation. 2008;118:2694-2701.)
© 2008 American Heart Association, Inc.

Heart Disease in Asia

Impact of Kidney Disease and Blood Pressure on the Development of Cardiovascular Disease

An Overview From the Japan Arteriosclerosis Longitudinal Study

Toshiharu Ninomiya, MD, PhD; Yutaka Kiyohara, MD, PhD; Yosuke Tokuda, MS; Yasufumi Doi, MD, PhD; Hisatomi Arima, MD, PhD; Akiko Harada, PhD; Yasuo Ohashi, PhD; Hirotsugu Ueshima, MD, PhD, for the Japan Arteriosclerosis Longitudinal Study Group

From the Department of Environmental Medicine (T.N., Y.K., H.A.) and Department of Medicine and Clinical Science (Y.D.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Biostatistics/Epidemiology and Preventive Health Sciences (Y.T., A.H., Y.O.), School of Health Sciences and Nursing, University of Tokyo, Tokyo, Japan; and Department of Health Science (H.U.), Shiga University of Medical Science, Otsu, Japan.

Correspondence to Yutaka Kiyohara, MD, PhD, Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka, 812-8582 Japan. E-mail kiyohara{at}envmed.med.kyushu-u.ac.jp

Background— Kidney disease is associated with an increased risk of cardiovascular disease (CVD); however, there have been few well-designed prospective studies of this issue in Asian populations. Recent epidemiological studies have suggested that a lower blood pressure level may be associated with an increased risk of CVD in individuals with kidney dysfunction.

Methods and Results— Using data from 10 community-based cohort studies in Japan, we conducted follow-up on a total of 30 657 individuals 40 to 89 years of age without preexisting CVD or kidney failure and examined the relationship between reduced glomerular filtration rate (GFR) and the risk of CVD. During an average 7.4-year follow-up, 727 individuals experienced CVD. The age- and sex-adjusted incidence of CVD increased significantly in subjects with GFR of 60 to 89 mL · min^–1 · 1.73 m^–2 (4.3 per 1000 person-years, P=0.002) and in those with a GFR <60 mL · min^–1 · 1.73 m^–2 (6.5, P<0.001) compared with those with a GFR 90 mL · min^–1 · 1.73 m^–2 (2.9). Even after adjustment for potential confounding factors, subjects with a GFR <60 mL · min^–1 · 1.73 m^–2 had a 57% (95% CI 14% to 115%) greater risk of CVD than those with a GFR 90 mL · min^–1 · 1.73 m^–2. The multivariate-adjusted hazard ratios of CVD increased in a log-linear manner with elevations in blood pressure levels, regardless of GFR levels (all P for trend <0.01).

Conclusions— Our findings suggest that a reduced GFR is a significant risk factor for CVD in the general Japanese population. Additionally, a log-linear association of blood pressure level with CVD risk was observed, without evidence of a J-curve association, regardless of GFR levels.

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