Impact of Kidney Disease and Blood Pressure on the Development of Cardiovascular Disease

Abstract

Background-Kidney disease is associated with an increased risk of cardiovascular disease (CVD); however, there have been few well-designed prospective studies of this issue in Asian populations. Recent epidemiological studies have suggested that a lower blood pressure level may be associated with an increased risk of CVD in individuals with kidney dysfunction. Methods and Results-Using data from 10 community-based cohort studies in Japan, we conducted follow-up on a total of 30 657 individuals 40 to 89 years of age without preexisting CVD or kidney failure and examined the relationship between reduced glomerular filtration rate (GFR) and the risk of CVD. During an average 7.4-year follow-up, 727 individuals experienced CVD. The age-and sex-adjusted incidence of CVD increased significantly in subjects with GFR of 60 to 89 mL · min Ϫ1 · 1.73 m Ϫ2 (4.3 per 1000 person-years, Pϭ0.002) and in those with a GFR Ͻ60 mL · min Ϫ1 · 1.73 m Ϫ2 (6.5, PϽ0.001) compared with those with a GFR Ն90 mL · min Ϫ1 · 1.73 m Ϫ2 (2.9). Even after adjustment for potential confounding factors, subjects with a GFR Ͻ60 mL · min Ϫ1 · 1.73 m Ϫ2 had a 57% (95% CI 14% to 115%) greater risk of CVD than those with a GFR Ն90 mL · min Ϫ1 · 1.73 m Ϫ2 . The multivariate-adjusted hazard ratios of CVD increased in a log-linear manner with elevations in blood pressure levels, regardless of GFR levels (all P for trend Ͻ0.01). Conclusions-Our findings suggest that a reduced GFR is a significant risk factor for CVD in the general Japanese population. Additionally, a log-linear association of blood pressure level with CVD risk was observed, without evidence of a J-curve association, regardless of GFR levels.

Impact of reduced renal function on prognosis in Japanese patients with coronary artery disease: a prospective cohort of Shinken Database 2007

“…Reports from Japan showed that 7-19% of adults have chronic kidney disease. [9][10][11]18,20 In addition, among Japanese patients with chronic heart failure or sleep-related breathing disorder, the prevalence of chronic kidney disease was reported to be 26.7 or 30.5%, respectively. 12,13 In this study, the prevalence of chronic kidney disease in all patients visiting our hospital (n¼6562), in patients with CAD (n¼797) or in patients with acute coronary syndrome (n¼291) was 19.9, 29.5 and 31.6%, respectively.…”

“…7,8 In real medical practice, physicians should always consider renal dysfunction in patients with preexisting or suspected CAD as a significant predictor. Although the prevalence of an estimated glomerular filtration rate (eGFR) in the general Japanese population, [9][10][11] patients with heart failure 12 or patients with sleep-related breathing disorder 13 has been reported earlier, the prevalence of chronic kidney disease and long-term prognosis in Japanese patients with CAD based on the eGFR value are less well identified.…”

Prognostic study of cardiac events in Japanese patients with chronic kidney disease using ECG-gated myocardial Perfusion imaging: Final 3-year report of the J-ACCESS 3 study

“…1,2 An estimated 13% of the Japanese adult population has CKD. 5,6 Several Japanese studies have indicated that the hazard ratio of the onset of myocardial infarction (MI) is 2.5-fold higher among Japanese men with CKD and without previous cardiovascular diseases (CVD) than in those without CKD 7,8 and in a Japanese population with eGFR \50 mL/minute/1.73 m 2 . 8 Although coronary angiography (CAG) has been the gold standard for detecting coronary artery disease (CAD), contrast media-induced nephropathy or cholesterol microembolization is serious adverse effects.…”

Chronic Kidney Disease, Dyslipidemia, and Atherosclerosis

“…In the Japan Arteriosclerosis Longitudinal Study 28) , Ninomiya et al calculated the risk of myocardial infarction, stroke, combined CVD, and all-cause mortality associated with reduced GFR in 30657 Japanese individuals 40 to 89 years of age without preexisting CVD or kidney failure. The age-and sex-adjusted hazards ratios for myocardial infarction, stroke, combined CVD, and all-cause death in subjects with GFR ＜60 mL/min/1.73 m 2 as compared with those with GFR ≥ 90 mL/min/1.73 m 2 were 3.35 (1.94-5.79), 2.06 (1.51-2.81), 2.26 (1.71-2.99), and 1.70 (1.44-2.00), respectively.…”