Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction

Anavekar, Nagesh S.; McMurray, John J.V.; Velázquez, Eric J.; Solomon, Scott D.; Køber, Lars; Rouleau, Jean‐Lucien; White, Harvey D.; Nordlander, Rolf; Maggioni, Aldo P.; Dickstein, Kenneth; Zelenkofske, Steven L.; Leimberger, Jeffrey D.; Califf, Robert M.; Pfeffer, Marc A.

doi:10.1056/nejmoa041365

Cited by 1,700 publications

(955 citation statements)

References 39 publications

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“…[1][2][3][4][5] In addition to the underlying primary pathological state, several factors, such as lifestyle, socioeconomic status (SES), and occupational exposures, were suggested to modify the progression and outcome of kidney diseases and may be responsible, in part, for the disproportionately high rates of end-stage renal disease in such subgroups as racial/ethnic minorities. [6][7][8][9][10] African Americans were reported to have greater rates of proteinuria.…”

mentioning

confidence: 99%

The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

Martins

Tareen

Zadshir

et al. 2006

American Journal of Kidney Diseases

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Background-Albuminuria is a major risk factor for the development and progression of chronic kidney disease (CKD) and cardiovascular disease. Socioeconomic factors also have been reported to modify CKD and cardiovascular risk factors and clinical outcomes. The extent to which poverty influences the prevalence of albuminuria, particularly among racial/ethnic minority populations, is not well established. The influence of poverty on the prevalence of albuminuria and the implication of this relationship for the racial and/or ethnic differences in the prevalence of albuminuria were examined.

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mentioning

confidence: 99%

The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

Martins

Tareen

Zadshir

et al. 2006

American Journal of Kidney Diseases

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“…A number of studies have reported the prognostic significance of eGFR in patients with CAD; [11][12][13][14][15][16][17][18] however, the majority of these studies were in Western countries and GFR was estimated by the MDRD equation or by creatinine clearance. Reports from Asian countries are very limited, possibly because of the lack of an accurate equation for eGFR in Asian populations.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies in which the prevalence of patients with eGFR o60 ml min À1 per 1.73 m 2 (that is, chronic kidney disease stage X3, according to the clinical guideline 21 ) was investigated in patients with CAD, showed that the prevalence of patients with eGFR o60 ml min À1 per 1.73 m 2 was 16-46% in Western countries. 11,12,[15][16][17][18] The MDRD equation or creatinine clearance was used in the majority of these studies. On the other hand, the prevalence of patients with eGFR o60 ml min À1 per 1.73 m 2 in Japanese patients with CAD was reported as 35 and 39% (Inaguma et al 13 and Furukawa et al 14 ) using MDRD equation with Japanese coefficient or creatinine clearance.…”

Section: Discussionmentioning

confidence: 99%

“…18 However, the relationship between eGFR values and the long-term prognosis following complete coronary revascularization has not been established. The aim of this study was to assess the relationship between eGFR by the new Japanese equation, as well as the long-term prognosis in a cohort of patients with CAD following complete revascularization.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization

et al. 2010

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An equation that accurately estimates the glomerular filtration rate (GFR) in the Japanese population has been proposed; however, the prognostic significance of estimated GFR (eGFR) defined according to this equation has not been reported. In addition, the prognostic significance of eGFR during long-term follow-up after complete coronary revascularization remains unclear. We assessed the prognostic significance of eGFR values, estimated by the new Japanese equation, in a cohort of patients following complete coronary revascularization. We studied consecutive patients with complete revascularization from 1984 to 1992. Patients on dialysis were excluded. A novel Japanese equation was used to estimate the GFR: eGFR¼ 194Â(serum creatinine) À1.094 Â(age) À0.287 (Â0.739 if female). Multivariate Cox proportional hazards regression analyses were performed to determine all-cause and cardiac mortality. We analyzed data of 1809 patients, of whom 571 (31.6%) had an eGFR of X90 ml min À1 per 1.73 m 2 , 917 (50.7%) had an eGFR of 60-89 ml min À1 per 1.73 m 2 , 298 (16.5%) had an eGFR of 30-59 ml min À1 per 1.73 m 2 and 23 (1.3%) had an eGFR of o30 ml min À1 per 1.73 m 2 . During follow-up (11.4 ± 2.9 years), there were 397 (22.0%) all-cause and 123 (6.8%) cardiac deaths overall. Patients with an eGFR of 30-59 ml min À1 per 1.73 m 2 , and o30 ml min À1 per 1.73 m 2 revealed significantly greater risk of all-cause mortality than those with eGFR of X90 ml min À1 per 1.73 m 2 (hazard ratio (HR) 1.91, Po0.001, HR 3.35, Po0.001, respectively). Furthermore, incidence of cardiac death was higher in patients with an eGFR of 30-59 ml min À1 per 1.73 m 2 than those with an eGFR of X90 ml min À1 per 1.73 m 2 (HR 2.89, Po0.001). GFR as estimated using the new Japanese equation had a prognostic significance among patients with complete coronary revascularization.

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“…6 High-risk patients, such as those with left ventricular dysfunction, have lower ejection fractions and higher New York Heart Association (NYHA) class when accompanied by impaired renal function. 8 Recently published data have reported the increased risk of CV disease once the glomerular filtration rate (GFR) dropped below 60 ml/min/1.73m 2 in patients at high CV risk 16 and the general population. 17 In combination, these data demonstrate that renal dysfunction imparts significant risk for CV disease.…”

Section: Discussionmentioning

confidence: 99%

Losartan and end-organ protection-lessons from the renaal study

et al. 2005

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Background: The Reduction in ENdpoints with the Angiotensin Antagonist Losartan (RENAAL) study reported that losartan delayed the progression of renal disease in patients with type 2 diabetes and nephropathy. Diabetic or renally impaired patients are at high cardiovascular risk, a risk potentially increased in patients with both conditions. Hypothesis: This post hoc analysis examined whether baseline proteinuria was predictive of cardiovascular outcomes, and whether losartan modifies the risk of cardiovascular outcomes in these patients given its renal‐protective effects. Methods: The RENAAL study compared losartan with placebo (in addition to conventional antihypertensive medications) in type 2 diabetic patients with proteinuria. Morbidity and mortality due to cardiovascular causes were ascertained, and the relationship between baseline proteinuria and cardiovascular outcome was determined. The effect of treatment with losartan was examined using three time‐to‐event analyses of composite cardiorenal outcomes as described below. Results: Increasing baseline proteinuria was associated with significantly increased risk of myocardial infarction (MI) and all‐cause or cardiovascular death, but not stroke. Losartan significantly reduced the risk for the combined endpoint of end‐stage renal disease (ESRD), MI, stroke, or death by 21% (p ≤ 0.005), irrespective of whether all‐cause or cardiovascular death was included in the analysis. In addition, losartan reduced the risk for the composite of ESRD or cardiovascular death by 19.2% (p < 0.05). Conclusion: In patients with type 2 diabetes and nephropathy, there is an increased risk of MI and cardiovascular or all‐cause mortality. Treatment with losartan is associated with a reduction in proteinuria, a delay in the onset of ESRD, and no increased risk of cardiovascular events in this pre‐ESRD population.

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Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction

Abstract: Even mild renal disease, as assessed by the estimated GFR, should be considered a major risk factor for cardiovascular complications after a myocardial infarction.

Cited by 1,700 publications

References 39 publications

The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

Prognostic significance of glomerular filtration rate estimated by the Japanese equation among patients who underwent complete coronary revascularization

Losartan and end-organ protection-lessons from the renaal study

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