Abstract. Chronic kidney disease (CKD) is a major public health problem. Conflicting evidence exists among community-based studies as to whether CKD is an independent risk factor for adverse cardiovascular outcomes. After subjects with a baseline history of cardiovascular disease were excluded, data from four publicly available, community-based longitudinal studies were pooled: Atherosclerosis Risk in Communities Study, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Serum creatinine levels were indirectly calibrated across studies. CKD was defined by a GFR between 15 and 60 ml/min per 1.73 m 2 . A composite of myocardial infarction, fatal coronary heart disease, stroke, and death was the primary study outcome. Cox proportional hazards models were used to adjust for study, demographic variables, educational status, and other cardiovascular risk factors.The total population included 22,634 subjects; 18.4% of the population was black, and 7.4% had CKD. There were 3262 events. In adjusted analyses, CKD was an independent risk factor for the composite study outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.07-1.32), and there was a significant interaction between kidney function and race. Black individuals with CKD had an adjusted HR of 1.76 (95% CI, 1.35-2.31), whereas whites had an adjusted HR of 1.13 (95% CI, 1.02-1.26). CKD is a risk factor for the composite outcome of all-cause mortality and cardiovascular disease in the general population and a more pronounced risk factor in blacks than in whites. It is hypothesized that this effect may be due to more frequent or more severe subclinical vascular disease secondary to hypertension or diabetes in black individuals.Chronic kidney disease (CKD) is a major public health problem. On the basis of clinical practice guidelines established by the National Kidney Foundation,~20 million adults in the United States have CKD, with 8 million of these classified as having moderate or severe kidney disease (1).In dialysis patients, cardiovascular disease (CVD) mortality rates are 10 to 30 times higher than in the general population (2). In high-risk patients, defined by the presence of either CVD or cardiovascular risk factors, less severe kidney disease is also an independent risk factor for CVD outcomes (3-12). However, in more representative community-based populations that were not selected for being at increased risk for CVD, there have been less consistent findings. Data from some studies suggest the absence of an independent association between the presence of CKD and CVD (13,14), whereas other data suggest that CKD is an independent risk factor for CVD outcomes (15-18). Previous studies may have been limited by insufficient power to examine subgroup relationships, in particular race, which may have caused discrepancies in these results.The purpose of the present study was to pool the findings from several large community-based cohort studies to evaluate more systematically whether CKD, as quantified by estimated GFR, ...

OPULAR DIETS HAVE BECOME INcreasingly prevalent and controversial. 1 More than 1000 diet books are now available, 2 with many popular ones departing substantially from mainstream medical advice. 3 Cover stories for major news magazines, televised debates, and cautionary statements by prominent medical authorities 4,5 have fueled public interest and concern regarding the effectiveness and safety of such diets. 6-8 Although some popular diets are based on long-standing medical advice and recommend restriction of portion sizes and calories (eg, Weight Watchers), 9 a broad spectrum of alternatives has evolved. Some plans minimize carbohydrate intake without fat restriction (eg, Atkins diet), 10 many modulate macronutrient balance and glycemic load (eg, Zone diet), 11 and others restrict fat (eg, Ornish diet). 12 Given the growing obesity epidemic, 13 many patients and clinicians are interested in using popular diets as individualized eating strategies for disease prevention. 14 Unfortunately, data regarding the relative benefits, risks, effectiveness, and For editorial comment see p 96.

The percentage of patients who present to the emergency department with acute myocardial infarction or unstable angina who are not hospitalized is low, but the discharge of such patients is associated with increased mortality. Failure to hospitalize is related to race, sex, and the absence of typical features of cardiac ischemia. Continued efforts to reduce the number of missed diagnoses are warranted.

The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study.

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