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. 2017 Jun 1;2(6):635-643.
doi: 10.1001/jamacardio.2017.0363.

Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease

Jing Chen  1 , Matthew J Budoff  2 , Muredach P Reilly  3 , Wei Yang  4 , Sylvia E Rosas  5 , Mahboob Rahman  6 , Xiaoming Zhang  4 , Jason A Roy  4 , Eva Lustigova  7 , Lisa Nessel  4 , Virginia Ford  8 , Dominic Raj  9 , Anna C Porter  10 , Elsayed Z Soliman  11 , Jackson T Wright Jr  6 , Myles Wolf  12 , Jiang He  1 ; CRIC Investigators
Affiliations

Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease

Jing Chen et al. JAMA Cardiol. .

Abstract

Importance: Coronary artery calcification (CAC) is highly prevalent in dialysis-naive patients with chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease and all-cause mortality in this population.

Objective: To study the prospective association of CAC with risk of cardiovascular disease and all-cause mortality among dialysis-naive patients with CKD.

Design, setting, and participants: The prospective Chronic Renal Insufficiency Cohort study recruited adults with an estimated glomerular filtration rate of 20 to 70 mL/min/1.73 m2 from 7 clinical centers in the United States. There were 1541 participants without cardiovascular disease at baseline who had CAC scores.

Exposures: Coronary artery calcification was assessed using electron-beam or multidetector computed tomography.

Main outcomes and measures: Incidence of cardiovascular disease (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every 6 months and confirmed by medical record adjudication.

Results: During an average follow-up of 5.9 years in 1541 participants aged 21 to 74 years, there were 188 cardiovascular disease events (60 cases of myocardial infarction, 120 heart failures, and 27 strokes; patients may have had >1 event) and 137 all-cause deaths. In Cox proportional hazards models adjusted for age, sex, race, clinical site, education level, physical activity, total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, use of antihypertensive treatment, current cigarette smoking, diabetes status, body mass index, C-reactive protein level, hemoglobin A1c level, phosphorus level, troponin T level, log N-terminal pro-B-type natriuretic peptide level, fibroblast growth factor 23 level, estimated glomerular filtration rate, and proteinuria, the hazard ratios associated with per 1 SD log of CAC were 1.40 (95% CI, 1.16-1.69; P < .001) for cardiovascular disease, 1.44 (95% CI, 1.02-2.02; P = .04) for myocardial infarction, 1.39 (95% CI, 1.10-1.76; P = .006) for heart failure, and 1.19 (95% CI, 0.94-1.51; P = .15) for all-cause mortality. In addition, inclusion of CAC score led to an increase in the C statistic of 0.02 (95% CI, 0-0.09; P < .001) for predicting cardiovascular disease over use of all the above-mentioned established and novel cardiovascular disease risk factors.

Conclusions and relevance: Coronary artery calcification is independently and significantly related to the risks of cardiovascular disease, myocardial infarction, and heart failure in patients with CKD. In addition, CAC improves risk prediction for cardiovascular disease, myocardial infarction, and heart failure over use of established and novel cardiovascular disease risk factors among patients with CKD; however, the changes in the C statistic are small.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Budoff reported receiving grants from the National Institutes of Health and General Electric. Dr Rahman reported receiving grants from the National Institutes of Health. Ms Nessel reported receiving funding from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr Wolf reported serving as a consultant to Amgen, Ardelyx, Diasorin, Lilly, Pfizer, Ultragenyx, Amag, Keryx, Sanofi, Incyte, and ZS; receiving grants from the National Institutes of Health and Shire; receiving payment for lectures from Sanofi; having an institutional patent pending; and owning stock in Keryx. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Chronic Renal Insufficiency Cohort Study Participants by Coronary Artery Calcification Score and Estimated Glomerular Filtration Rate
A score of 0 indicates no coronary artery calcification; greater than 0 to 100, moderate calcification; greater than 100, severe calcification.
Figure 2.
Figure 2.. Kaplan-Meier Cumulative Event Rate of Cardiovascular Disease, Myocardial Infarction, Heart Failure, and All-Cause Mortality According to Coronary Artery Calcification Score Among Chronic Renal Insufficiency Cohort Participants Without a History of Cardiovascular Disease
A score of 0 indicates no coronary artery calcification; greater than 0 to 100, moderate calcification; greater than 100, severe calcification. Cardiovascular disease included myocardial infarction, heart failure, and stroke.
Figure 3.
Figure 3.. Multivariable-Adjusted Hazard Ratios of Cardiovascular Disease by ACC/AHA Atherosclerotic Cardiovascular Disease Risk Score and CAC Score Among Chronic Renal Insufficiency Cohort Participants Without a History of Cardiovascular Disease
Error bars indicate 95% CIs; ACC, American College of Cardiology; AHA, American Heart Association; CAC, coronary artery calcification. A CAC score of 0 indicates no calcification; greater than 0 to 100, moderate calcification; greater than 100, severe calcification.
See this image and copyright information in PMC

Comment in

References

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