CKD and Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study: Interactions With Age, Sex, and Race

Hui, Xuan; Matsushita, Kunihiro; Sang, Yingying; Ballew, Shoshana H.; Fülöp, Tibor; Coresh, Josef

doi:10.1053/j.ajkd.2013.04.010

Cited by 80 publications

(60 citation statements)

References 44 publications

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“…In a large meta-analysis, Nitsch et al [16] found that the slope of the CV mortality risk relationship was steeper in women, indicating that they were at least as influenced by moderately and severely increased albuminuria as men. Likewise, Hui et al [17] similarly observed stronger associations of ACR with CV morbidity risk in women in a US cohort study (1.3-1.8 fold higher HRs). Our results also indicated higher HRs in women but were not statistically different from men.…”

Section: Discussionmentioning

confidence: 88%

“…Nitsch et al [16] demonstrated in the 2.1 million CKD-Prognosis Consortium cohort that women have a steeper increase in all-cause and CV mortality risk at ACR levels >2.5 mg/mmol. Hui et al [17] tested possible interactions with age, gender and race in the ARIC cohort with incident CVD as outcome. They found that albuminuria was associated with a higher risk in women.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Hatlen

Romundstad²,

Salvesen³

et al. 2016

Nephron

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Background: The association between albuminuria and coronary heart disease (CHD) is well-known, but uncertainties related to day-to-day variability and effect modification of gender complicate the risk assessment process. This study evaluates the associations of CHD with albuminuria level in men and women based on the number of urine samples. Methods: Nine thousand one hundred and fifty-eight adults provided 3 urine samples and were followed for 14 years in the population-based HUNT-2 cohort study. The association of myocardial infarction or coronary death with different albumin-creatinine ratio (ACR) cut-offs, based on gender and number of positive ACRs, were estimated by hazard ratios (HRs) and adjusted for by Framingham variables. Results: Associations between ACR and CHD were similar in men and women. For example, HRs for moderately increased (3.0≤ ACR ≤30.0 mg/mmol) vs. normal albuminuria (ACR <1.0 mg/mmol) were 1.40 (95% CI 1.27-2.03) and 1.61 (95% CI 1.15-1.71) respectively, (p_sex-equality = 0.3). However, median intra-individual day-to-day ACR coefficient of variation was 22.4% in women vs. 17.5% in men (p < 0.001). Two or 3 positive ACRs were required to establish a significant association with CHD at levels below 4.0 mg/mmol in women, while one positive ACR implied a significant association at all levels in men. Based on receiver-operating-characteristics curves, the Youden index suggested possible equal cut-offs for women (1.12 mg/mmol) and men (0.88 mg/mmol), p = 0.06. Conclusions: There were no significant gender differences in the association between albuminuria and coronary events. However, women had increased intra-individual albuminuria variability compared to men, necessitating several positive urine samples if mildly increased albuminuria is used in coronary risk evaluation.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Hatlen

Romundstad²,

Salvesen³

et al. 2016

Nephron

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“…[1][2][3][4][5] Tonelli et al 14 reported that, among individuals without a history of previous † Or non-HDL-C=100-219 mg/dl. 10 On the basis of these results, the KDIGO Lipid Work Group concluded that all individuals with CKD $50 years of age should be considered in the highest risk group for future coronary events and treated with statins.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Data from randomized trials have shown that statins reduce the risk for ASCVD events and cardiovascular mortality among individuals with CKD not on dialysis. [6][7][8][9] On the basis of the high absolute risk for ASCVD among individuals with CKD in conjunction with results from clinical trials, the 2013 Kidney Disease Improving Global Outcomes (KDIGO) Foundation Clinical Practice Guideline for Lipid Management in CKD recommended that all adults 50 years of age or older with CKD not on dialysis should be taking a statin.…”

mentioning

confidence: 99%

Contrasting Cholesterol Management Guidelines for Adults with CKD

Colantonio¹,

Baber

Banach

et al. 2015

Journal of the American Society of Nephrology

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The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins for adults $50 years old with CKD. The American College of Cardiology/American Heart Association endorses statins for adults with atherosclerotic cardiovascular disease, adults with LDL cholesterol$190 mg/dl, and adults 40-79 years old with LDL cholesterol=70-189 mg/dl and diabetes or a 10-year predicted risk for atherosclerotic cardiovascular disease $7.5% estimated using the Pooled Cohort risk equations. Using data from the Reasons for Geographic and Racial Differences in Stroke Study, we calculated the agreement for statin treatment between these two guidelines for adults 50-79 years old with CKD (eGFR,60 ml/min per 1.73 m 2 or albuminuria$30 mg/g) not on dialysis. We assessed the validity of the Pooled Cohort risk equations in individuals with CKD. Study participants were enrolled between 2003 and 2007, and we report incident cardiovascular disease events (stroke and coronary heart disease) through December of 2010. Among 4726 participants with CKD, 2366 (50%) were taking statins, and 1984 (42%) were recommended statins by the American College of Cardiology/American Heart Association guideline but not taking them. Overall, 376 (8%) participants did not meet the American College of Cardiology/American Heart Association criteria for initiating statin treatment. Cardiovascular disease incidence was low (3.0/1000 person-years; 95% confidence interval, 0.1 to 5.9) among these participants. The Pooled Cohort risk equations were well calibrated (Hosmer-Lemeshow chi-squared=2.7, P=0.45) with moderately good discrimination (C index, 0.71; 95% confidence interval, 0.65 to 0.77). In conclusion, these guidelines show high concordance for statin treatment for adults with CKD.

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“…For universal thresholds, the use of this standard is recommended regardless of age, gender, and ethnic group. However, the relation between demographic factors and the impacts of eGFR and albuminuria on CVD is understudied [15].…”

Section: Introductionmentioning

confidence: 99%

The Impacts of Albuminuria and eGFR on Cardiovascular Disease

Hu¹

2017

AJHR

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Albuminuria is often used as a surrogate marker for the risk of fatal and non-fatal events in clinical trials of antihyperglycemic medications or in antihypertensive therapy. Similarly, low estimated glomerular filtration rate (eGFR), which is a common manifestation of progressed diabetic nephropathy, has also been demonstrated to be an independent risk factor for cardiovascular events and death. Recent evidence suggests that both high albuminuria and low eGFR are independent risk factors for progressive kidney failure and cardiovascular disease. The purpose of this study was to investigate the impacts of albuminuria and low eGFR on the risk of cardiovascular disease. A cross-sectional design was used. Data were collected through adults' health examinations by a hospital in a certain area in Pingtung County between 2011 and 2015. The health data base included participants' basic information, physical examination and blood examination results. Use abbreviated modification of diet in renal disease, aMDRD (Abbreviated modification of diet in renal disease) formula to estimate eGFR. Use metabolic syndrome to define the criteria of rising blood pressure, blood sugar, blood lipids as an important cardiovascular disease (CVD) indicator and then calculation of the 10-year risk for CVD was completed using data from the Framingham Heart Study and a computer was used to determine risk values. In this study, ≤ 10% was defined as low risk, 11-20% was defined as moderate risk, and > 20% was defined as high risk. As albuminuria and eGFR approached critically high values, initially moderate and high 10-year risk levels for CVD tended to increase. Logistic regression analysis showed that patients with severe albuminuria and severe eGFR had higher risks of metabolic syndrome, abnormal waist circumference, hyperglycemia, reduced high-density lipoprotein cholesterol (HDL-C), hypertriglyceridemia, and elevated blood pressure. The study concluded that albuminuria and eGFR are risk factors for CVD and can increase a patient's 10-year risk of CVD.

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CKD and Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study: Interactions With Age, Sex, and Race

Cited by 80 publications

References 44 publications

Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Contrasting Cholesterol Management Guidelines for Adults with CKD

The Impacts of Albuminuria and eGFR on Cardiovascular Disease

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