Abstract 3682: Mortality from Coronary Heart Disease in Subjects with Moderate Chronic Kidney Disease is Comparable with Subjects with Prior Myocardial Infarction and also Patients with Diabetes
Introduction. Chronic kidney disease (CKD) and DM are important CAD risk factors. Whether CKD is a cardiovascular risk equivalent, like DM, is the matter of debate.
Hypothesis. Moderate CKD is a cardiovascular disease risk equivalent.
Method. The Cardiovascular Health Study (CHS) limited access data base, obtained from NHLBI, was used to identify a cohort of patients with a baseline history of myocardial infarction (MI), DM or CKD (eGFR < 60 ml/min). eGFR was calculated using MDRD equation and based on indirect calibration of serum creatinine. Based on having exclusive risk factors, subjects were subsequently categorized to one of three groups: 1- Patients with DM (no CKD or MI), 2- Patients with MI (no DM or CKD), and 3- Patients with CKD, (no DM or MI). Patients were subsequently followed for a mean duration of 8.6 years (SD=2.7) and rates of cardiovascular mortality were compared using proportional hazards regression.
Results. There were 789 people in MI group, 443 people in DM group and 667 people in CKD group. During the follow up period, 221 (28%) patients died because of cardiovascular cause in MI group and the rate was 128 (28.9%) and 176 (26.4%) in DM and CKD groups respectively. After adjustment for age, race, sex, smoking, HTN, cholesterol and HDL levels, in proportional hazard analysis, the risk ratio of cardiovascular events in CKD and DM groups were 0.89 (95%CI, 0.73–1.09) and 1.15 (95%CI, 0.92–1.44), compared to MI group, respectively.
Conclusion. Moderate CKD alone without DM and previous history of MI is strongly associated with cardiovascular mortality. The risk of cardiovascular mortality in CKD patients is as high as patients with previous history of MI or DM.