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

Abstract

Importance Coronary artery calcification (CAC) is highly prevalent in patients with pre-dialysis chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease (CVD) and all-cause mortality in this population. Objectives To study the prospective association of CAC with risk of CVD and all-cause mortality among patients with pre-dialysis CKD. Design, Setting, and Participants Chronic Renal Insufficiency Cohort study recruited adults aged 21–74 years with an estimated-glomerular filtration rate (eGFR) of 20–70 mL/min/1.73 m2 from seven clinical centers in the US. Of them, 1,541 participants without CVD at baseline who had CAC measures were included in current analyses. Exposure CAC was assessed by electron-beam computed tomography or multi-detector computed tomography. Main Outcomes and Measures Incidence of CVD (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every six months and confirmed by medical record adjudication. Results During an average of 5.9 years of follow-up, we observed 188 CVD (60 myocardial infarction, 120 heart failure, and 27 stroke) and 137 deaths. In Cox proportional hazards models adjusted for age, gender, race, clinical site, education, physical activity, total cholesterol, HDL-cholesterol, systolic blood pressure, antihypertensive treatment, current cigarette smoking, diabetes, body-mass index, C-reactive protein, hemoglobin A1c, phosphate, troponin T, log-N-terminal pro-B-type natriuretic peptide, fibroblast growth factor-23, eGFR, and proteinuria, the hazard ratios (95% confidence interval [CI]) associated with one standard deviation of CAC were 1.40 (1.16 to 1.69, p<.001) for CVD, 1.44 (1.02 to 2.02, p=.04) for myocardial infarction, 1.39 (1.10 to 1.76, p=.006) for heart failure, and 1.19 (0.94 to 1.51, p=.15) for all-cause mortality. In addition, inclusion of CAC score led to significant increase in c-statistic 0.02 (95% CI 0.00 to 0.09, p<.001) for predicting CVD over all above-mentioned established and novel CVD risk factors. Conclusion and Relevance CAC is independently and significantly related to the risks of CVD, myocardial infarction, and heart failure in CKD patients. In addition, CAC improves risk prediction for CVD, myocardial infarction, and heart failure over established and novel CVD risk factors among CKD patients, although the change in c-statistics is small.

Fruit and Vegetable Treatment of Chronic Kidney Disease-Related Metabolic Acidosis Reduces Cardiovascular Risk Better than Sodium Bicarbonate

“…Such a diet is also associated with reduced lowdensity lipoprotein cholesterol (LDL-c) [17], and decreased LDL-c predicts a reduction in major CVD events in CKD [18]. Furthermore, high F + V diets are associated with reduced risk of coronary artery calcification (CAC) [19], which independently predicts CVD risk over and above more traditional CVD risk factors in the general population [20], is more common and more severe in CKD [21], and has stronger association with risk of CVD and mortality in CKD patients [22]. Vitamin K-dependent matrix Gla protein contributes to the physiologic prevention of CAC [23], and low vitamin K status common in CKD patients [24] might be corrected by increased F + V intake.…”

Arterial Stiffness as a Risk Factor for Subclinical Coronary Artery Calcification in Predialysis Chronic Kidney Disease: From the KNOW-CKD Study

“…As mentioned above, recent studies have found that subclinical atherosclerosis detected as CAC is a predictor of CVD and high CV mortality in CKD patients as well as in the general population [12, 13]. However, coronary calcium scoring requires high costs, skilled expertise, and risk of radiation exposure.…”

“…Coronary artery calcification (CAC) was recently established as a predictor of CV complications in the general population and is recommended for use in assessing CV risk in asymptomatic adults with intermediate risk [11]. Recent studies have identified CAC as a predictor of CV disease and mortality in CKD patients, suggesting the possibility of a risk prediction tool for CKD [12, 13]. …”

Vascular Calcification and Osteoprotegrin in Chronic Kidney Disease

“…This important question has been addressed recently by Chen et al [5] in JAMA Cardiology . This prospective study included adults with CKD who were dialysis-naïve.…”