Ethnic disparities in cardiovascular risk factors and coronary disease prevalence among individuals with chronic kidney disease: findings from the Third National Health and Nutrition Examination Survey

Abstract

Differences in coronary disease have been reported among ethnic minorities in the US population. Whether these persist in patients with chronic kidney disease is unknown. The prevalence of myocardial infarction (MI) and angina was compared by race and GFR in the Third National Health and Nutrition Examination Survey using the Modification of Diet in Renal Disease Study equation. Age-gender standardized estimates were computed for each GFR category (>or=90, 60 to 89, and <60 ml/min per 1.73 m2), and odds ratios were compared using weighted multivariable logistic regression for each race. The age-gender standardized prevalence of MI was 3.0, 3.1, and 4.9% in white individuals; 2.8, 3.8, and 9.9% in black individuals; and 1.9, 2.9, and 3.8% in Mexican-American individuals in each category: >or=90, 60 to 89, and <60 ml/min, respectively. Compared with the referent (Mexican-American; GFR>or=90 ml/min; odds ratio 1.00), Mexican-American individuals with GFR of 60 to 89 and <60 ml/min had more than four and nine times the odds for MI; black individuals at successively lower GFR levels had 1.6, 6.1, and 16.3 times the odds for MI, whereas white individuals had 1.9, 4.7, and 20.2 times that of the referent, respectively. After adjustment for traditional risk factors, the inverse association of GFR with MI was substantially attenuated in black and white individuals and completely abolished in Mexican-American individuals. The burden of coronary disease is lower in Mexican-American than in white or black individuals with reduced kidney function even accounting for differences in traditional risk factors.