Abstract 3866: Predictors of Coronary Atherosclerosis Differ Between Patients with and without Chronic Kidney Disease
Background: Traditional risk factors do not fully account for the excess cardiovascular disease (CVD) risk among patients with chronic kidney disease (CKD). We assessed the associations between traditional and novel CVD risk factors and coronary artery calcification (CAC) among a cohort of subjects with and without CKD.
Methods: Included were 2,646 participants of the Dallas Heart Study, a probability-based population sample of Dallas County. CKD was defined as calculated glomerular filtration rate < 60 ml/min per 1.73 m2, or presence of microalbuminuria. Prevalent CAC was defined as Agatston score > 10. Forward stepwise logistic regression was used to test the independent association between risk factors and CAC among groups with and without CKD. Traditional and non-traditional risk factors including elevated homocysteine (greater than 50th percentile), small LDL (mg/dl cholesterol), calcium x phosphorus product (CPP), Monocyte chemoattractant protein-1 (MCP-1), Lp (a) and osteoprotegerin were assessed.
Results: CAC prevalence was 38% among those with CKD and 20% among those without, p < 0.0001. Age, sex, smoking, and CPP independently predicted CAC in both groups; hypertension, diabetes, and hypercholesterolemia were significant predictors only in the No CKD group, whereas homocysteine, and small LDL were only significant predictors in those with CKD.
Conclusion: Potentially important differences exist in the risk factor profile for CAC in subjects with and without CKD. While more traditional risk factors such as hypercholesterolemia, hypertension and diabetes were not independently associated with CAC in subjects with CKD, homocysteine and small LDL were. These differences in risk factors require further investigation to explore possible mechanistic links and to define any potential therapeutic targets for CVD prevention in CKD. Independent predictors of CAC according to CKD status