Cigarette smoking and cardio-renal events in patients with atherosclerotic renal artery stenosis

Abstract

Cigarette smoking causes cardiovascular disease and is associated with poor kidney function in individuals with diabetes mellitus and primary kidney diseases. However, the association of smoking on patients with atherosclerotic renal artery stenosis has not been studied. The current study utilized data from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL, NCT00081731) clinical trial to evaluate the effects of smoking on the risk of cardio-renal events and kidney function in this population. Baseline data showed that smokers (n = 277 out of 931) were significantly younger at enrollment than non-smokers (63.3±9.1 years vs 72.4±7.8 years; p<0.001). In addition, patients who smoke were also more likely to have bilateral renal artery stenoses and peripheral vascular disease (PVD). Longitudinal analysis showed that smokers experienced composite endpoint events (defined as first occurrence of: stroke; cardiovascular or renal death; myocardial infarction; hospitalization for congestive heart failure; permanent renal replacement; and progressive renal insufficiency defined as 30% reduction of GFR from baseline sustained for ! 60 days) at a substantially younger age compared to non-smokers (67.1±9.0 versus 76.1±7.9, p<0.001). Using linear regression and generalized linear modeling analysis controlled by age, sex, and ethnicity, smokers had significantly higher cystatin C levels (1.3±0.7 vs 1.2±0.9, p<0.01) whereas creatinine and estimated glomerular filtration rate (eGFR) were not different from non-smokers. From these data we conclude that smoking has a significant association with deleterious cardio-renal outcomes in patients with renovascular hypertension.

Diabetes Mellitus and Noncardiac Atherosclerotic Vascular Disease—Pathogenesis and Pharmacological Treatment Options

“…Drummond et al reported that active smoking results in clinically significant ARAS, and adverse cardiorenal events, at much younger age; clearly, there is a need for smoking cessation. 111 Overall, the optimal treatment for ARAS remains poorly defined.…”

An alternative empirical likelihood method in missing response problems and causal inference

“…Cigarette smoking may worsen renal function in people with diabetes mellitus and primary kidney diseases [25][26][27][28]; however, the effect of cigarette smoking on renal function in patients with atherosclerotic renal artery stenosis (ARAS) is uncertain. In this context, we apply our proposed method and several other methods on a dataset from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) clinical trial [29] to study the causal effect of cigarette smoking on renal function in patients with ARAS [30]. The CORAL study was a prospective, international, randomized clinical trial that compared medical therapy only with medical therapy plus stenting in patients with ARAS, followed from May 2005 to January 2010.…”