Abstract 10820: Novel Risk Factors for Coronary Artery Calcification Among Patients with Chronic Kidney Disease: The CRIC Study
Background: Cardiovascular disease is the leading cause of death in patients with chronic kidney disease (CKD). We examined the cross-sectional association between novel risk factors and coronary artery calcification (CAC) among patients with CKD.
Methods and Results: An electron-beam computed tomography (EBCT) or multidetector CT was performed in 2,018 participants of the chronic renal insufficiency cohort (CRIC) study. Based on total Agatston scores, patients with CKD were classified as no (0), moderate (>0-100) or severe (>100) CAC. After adjustment for age, sex, race, and CRIC clinical sites, phosphate, alkaline phosphatase, insulin resistance, hemoglobin A1c, uric acid, homocysteine, fibrinogen, interleukin-6, tumor necrosis factor-α, cystatin C, and 24-hour urine albumin were all significantly associated with severe CAC. After additional adjustment for cigarette smoking, history of cardiovascular disease, hypertension, and diabetes, use of lipid-lowering drugs, body mass index, and waist circumference, several novel risk factors remained significantly associated with severe CAC. For example, odds ratios (95% confidence interval) of severe CAC associated with one standard deviation higher levels of risk factors were 1.30 (1.13, 1.50) for phosphate, 1.20 (1.03, 1.41) for insulin resistance, 1.22 (1.03, 1.44) for hemoglobin A1c, 1.14 (1.00, 1.31) for homocysteine, 1.17 (1.01, 1.34) for fibrinogen, and 1.31 (1.14, 1.50) for cystatin C.
Conclusions: These data indicate that phosphate metabolism, insulin resistance, homocysteine, thrombotic state and kidney function were associated with increased risk of CAC in patients with CKD. Further studies are warranted to examine the causal effect of these risk factors on CAC in CKD patients.
- © 2011 by American Heart Association, Inc.