Kidney Stones and Cardiovascular Events

Abstract

Background and objectives Kidney stones are common in general clinical practice, and their prevalence is increasing. Kidney stone formers often have risk factors associated with atherosclerosis, but it is uncertain whether having a kidney stone is associated with higher risk of cardiovascular events. This study sought to assess the association between one or more kidney stones and the subsequent risk of cardiovascular events.Design, setting, participants, & measurements Cohort study of 3,195,452 people aged$18 years registered in the universal health care system in Alberta, Canada, between 1997 and 2009 (median follow-up of 11 years). People undergoing dialysis or with a kidney transplant at baseline were excluded. The primary outcome was the first acute myocardial infarction (AMI) during follow-up. We also considered other cardiovascular events, including death due to coronary heart disease, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass grafting (CABG), and stroke.Results In total, 25,532 (0.8%) participants had at least one kidney stone, and 91,465 (3%) individuals had at least one cardiovascular event during follow-up. Compared with people without kidney stones and after adjustment for cardiovascular risk factors and other potential confounders, people who had at least one kidney stone had a higher risk of subsequent AMI (adjusted hazard ratio [HR], 1.40; 95% confidence interval [95% CI], 1.30 to 1.51), PTCA/CABG (HR, 1.63; 95% CI, 1.51 to 1.76), and stroke (HR, 1.26; 95% CI, 1.12 to 1.42). The magnitude of the excess risk associated with a kidney stone appeared more pronounced for younger people than for older people (P,0.001) and for women than men (P=0.01).Conclusions The occurrence of a kidney stone is associated with a higher risk of cardiovascular events, including AMI, PTCA/CABG, and stroke.

The relationship between calcium kidney stones, arterial stiffness and bone density: unraveling the stone-bone-vessel liaison

“…This is in accordance with epidemiologic studies indicating that idiopathic calcium renal stone formers, the great majority of renal stone patients, are at increased risk of cardiovascular events. The data also suggest that results obtained by previous cohort studies disclosing an association with increased carotid intima-media thickness, and CV endpoints, respectively [2,13,14,19], are probably explained by the higher CV risk imparted by idiopathic calcium stones rather than by other special kind of stone formers, for example the urate stone patients.…”

“…Recently, three prospective studies have confirmed that incident stone formers have a 20-60 % higher risk of having incident CV episodes [2,13,14]. However, the epidemiological design of those studies had precluded the possibility to ascertain whether the risk is associated with a specific phenotype of renal stone disease.…”

Vascular Calcification and Bone Mineral Density in Recurrent Kidney Stone Formers

“…In a prospective study of 45,748 men and 196,357 women from the United States, Ferraro et al demonstrated that among women, those with a reported history of kidney stones had a significantly higher adjusted risk of CVD than those without a history of kidney stones (4). Finally, in a recent cohort study of 3,195,452 people, the occurrence of a kidney stone was associated with a higher risk of acute MI, percutaneous transluminal coronary angioplasty/coronary artery bypass grafting, and stroke (16).…”

Vascular theory of the formation of Randall plaques

“…Several epidemiological studies have suggested an association between urolithiasis, adverse cardiovascular events, and vascular calcification risk factors such as obesity and diabetes mellitus [14]. Although risk factors for urinary stone disease are recognized, only the mere association between the two is known, not causation.…”