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. 2020 Oct:310:75-82.
doi: 10.1016/j.atherosclerosis.2020.07.026. Epub 2020 Aug 5.

Coronary artery calcium progresses rapidly and discriminates incident cardiovascular events in chronic kidney disease regardless of diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)

Gautam R Shroff  1 , Otto A Sanchez  2 , Michael D Miedema  3 , Holly Kramer  4 , Joachim H Ix  5 , Daniel A Duprez  6 , David R Jacobs Jr  7
Affiliations

Coronary artery calcium progresses rapidly and discriminates incident cardiovascular events in chronic kidney disease regardless of diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)

Gautam R Shroff et al. Atherosclerosis. 2020 Oct.

Abstract

Background and aims: Chronic kidney disease (CKD) is associated with high prevalence of cardiovascular disease (CVD) events. We sought to assess the prognostic utility of coronary artery calcium (CAC) scores in discriminating incident CVD events among subpopulations of CKD, particularly those without diabetes mellitus (DM).

Methods: Using the Multi-Ethnic Study of Atherosclerosis, we identified 4 groups based on present/absent CKD/diabetes (CKD-/DM-, n = 5308; CKD-/DM+, n = 586, CKD+/DM-, n = 620; CKD+/DM+, n = 266). Baseline and follow-up CAC (Agatston units) measurements, and association between CAC and incident CVD events in median follow-up of 13 years were evaluated using proportional hazards regression adjusting for demographics, clinical, biomarker variables.

Results: Prevalence of CKD and DM in the cohort was 13% and 12.5% respectively. Annual progression in adjusted median CAC score was 24.8%, 27.9%, 26.7%, 36.8% and unadjusted cumulative incident CVD rates were 12.6%, 22.3%, 23.1%, 39.8% for CKD-/DM-, CKD-/DM+, CKD+/DM-, CKD+/DM+, respectively. After full adjustment (CKD-/DM-referent), hazard ratios (HR, 95% CI) for incident CVD events were 1.25 (1.01-1.53) CKD-/DM+, 1.10 (0.90-1.33) CKD+/DM- and 2.18 (1.73-2.76) CKD+/DM+. Using CKD-/DM-/baseline CAC = 0 referent, adjusted HRs (95% CI) for incident CVD in CKD+/DM- were 1.30 (0.81-2.07), 2.05 (1.4-2.99), and 4.15 (2.94-5.86) for baseline CAC = 0, 1-100, and >300 Agatston units respectively while for CKD+/DM+, adjusted HRs were 3.15 (2.04-4.86), 3.56 (2.26-5.62), 7.90 (5.35-11.67), respectively.

Conclusions: CAC provides incremental prognostic information to predict incident CVD events in CKD regardless of DM. Moreover, baseline CAC categories discriminate incident CVD among CKD without DM, which may have implications in individualizing approach to primary prevention in this high-risk population.

Keywords: Cardiovascular disease; Chronic kidney disease; Coronary calcification; Diabetes.

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Conflict of interest statement

Declaration of competing interests

The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier curves demonstrating unadjusted incident CVD probabilities, further elucidated by the presence of CKD and DM as well as CAC categories. CAC = coronary artery calcium score in Agatston units. CVD = age-specific unadjusted incident cardiovascular disease events. CKD = chronic kidney disease, DM = diabetes mellitus.
See this image and copyright information in PMC

References

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