Kidney dysfunction and fatal cardiovascular disease - an association independent of atherosclerotic events: Results from the Health, Aging, and Body Composition (Health ABC) study
ABSTRACT Impaired kidney function has been associated with increased risk for death, myocardial infarction, stroke, and heart failure in high-risk populations. We evaluated whether impaired kidney function predicted risk of fatal cardiovascular disease independent of prevalent and incident cardiovascular events.
The Health, Aging, and Body Composition study is a cohort of well-functioning, elderly participants aged 70 to 79 years at entry. We measured serum cystatin C and creatinine from baseline plasma samples of 3044 participants and followed them over 6 years, examining the associations among kidney function, cardiovascular death, and incident cardiovascular events. Cystatin C was categorized as low (< 0.84 mg/L), medium (0.84-1.18 mg/L), or high (> or = 1.19 mg/L); serum creatinine (cutoff value of > or = 1.3 in women and > or = 1.5 in men) and estimated glomerular filtration rate (eGFR; greater and less than 60 mL/min per 1.73 m2) were dichotomized.
During follow-up, 242 cardiovascular deaths occurred, of which 69 were in participants without prior cardiovascular events; 294 incident cardiovascular events occurred including 135 myocardial infarctions and 163 strokes. Higher cystatin C concentrations were significantly associated with cardiovascular death (adjusted hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.05-2.76 for the medium cystatin C group; and HR 2.24, 95% CI 1.30-3.86 for the high cystatin C group, relative to the low cystatin C group). The point estimate was of greater magnitude in the analysis that excluded prevalent cardiovascular disease (adjusted HR 2.68, 95% CI 0.94-7.70 for the medium cystatin C group; and HR 4.91, 95% CI, 1.55-15.54 for the high cystatin C group). Elevated creatinine levels (adjusted HR 1.54, 95% CI 1.02-2.33, and HR 2.28, 95% CI 1.10-4.73 among participants without a history of cardiovascular disease) were also associated with cardiovascular death. No significant association was found between low eGFR and cardiovascular death. In addition, cystatin C, low eGFR, or elevated creatinine levels were not associated with other cardiovascular events.
Impaired kidney function is a strong predictor of cardiovascular death, particularly among participants without prior history of cardiovascular disease.
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ABSTRACT: OBJECTIVE We aim to explore whether a link exists between different levels of estimated glomerular filtration rate (eGFR) and poor outcomes of acute stroke in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS Between 2007 and 2009, 6261 patient with cerebrovascular events and diabetes were included in the final analysis from the China National Stroke Registry (CNSR) and substudy of CNSR (abnormal glucose regulation in patients with acute stroke across China, ACROSS).The period of follow-up was one year after stroke onset. eGFR was calculated with the Chinese modification of chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The association between eGFR and poor stroke outcomes including all-cause death, recurrent stroke, combined endpoint (stroke or death) and stroke disability was evaluated by multivariate analysis with the adjustment for demographic and clinical features.RESULTSOf 4836 patients with stroke, low eGFR (< 45 ml/min/1.73m(2)) occurred in 268 (5.5%) and high eGFR (≥ 120 ml/min/1.73m(2)) in 387 (8.0%). The median value for eGFR in all patients was 92.6 ml/min/1.73m(2). Low eGFR was independently associated with risks of all of clinical outcomes in stroke/TIA patients or patients with ischemic events, but not in patients with the hemorrhagic stroke. Additionally, high eGFR was positively associated with an increased risk of adverse outcomes in all of stroke subtypes including hemorrhagic stroke.CONCLUSIONS Low and high eGFRs (<45 ml/min/1.73m(2) or ≥120 ml/min/1.73m(2), respectively) are independent predictors of all-cause mortality and other poor outcomes after acute stroke in patients with type 2 diabetes.Diabetes care 09/2013; 37(1). DOI:10.2337/dc13-1931 · 8.57 Impact Factor
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ABSTRACT: Sudden cardiac death continues to be a major public health problem. Ventricular arrhythmia is a main cause of sudden cardiac death. The present review addresses the links between renal function tests, several laboratory markers, and ventricular arrhythmia risk in patients with renal disease, undergoing or not hemodialysis or renal transplant, focusing on recent clinical studies. Therapy of hypokalemia, hypocalcemia, and hypomagnesemia should be an emergency and performed simultaneously under electrocardiographic monitoring in patients with renal failure. Serum phosphates and iron, PTH level, renal function, hemoglobin and hematocrit, pH, inflammatory markers, proteinuria and microalbuminuria, and osmolarity should be monitored, besides standard 12-lead ECG, in order to prevent ventricular arrhythmia and sudden cardiac death.BioMed Research International 05/2014; 2014. DOI:10.1155/2014/509204 · 2.71 Impact Factor
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ABSTRACT: After 2 decades of development and use in interventional cardiology research, optical coherence tomography (OCT) has now become a core intravascular imaging modality in clinical practice. Its unprecedented spatial resolution allows visualization of the key components of the atherosclerotic plaque that appear to confer "vulnerability" to rupture-namely the thickness of the fibrous cap, size of the necrotic core, and the presence of macrophages. The utility of OCT in the evaluation of plaque composition can provide insights into the pathophysiology of acute coronary syndrome and the healing that occurs thereafter. A brief summary of the principles of OCT technology and a comparison with other intravascular imaging modalities is presented. The review focuses on the current evidence for the use of OCT in identifying vulnerable plaques in acute coronary syndrome and its limitations. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.JACC Cardiovascular Imaging 02/2015; 8(2):198-209. DOI:10.1016/j.jcmg.2014.12.005 · 6.99 Impact Factor