Chronic Renal Insufficiency and Cardiovascular Events in the Elderly: Findings From the Cardiovascular Health Study

Authors

  • Michael G. Shlipak MD, MPH,

    1. From the General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA;1 the Department of Medicine, University of California, San Francisco, CA;2 the Departments of Medicine,3 and Epidemiology,4University of Pittsburgh School of Medicine, Pittsburgh, PA; the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA;5 the Section of Nephrology, Seattle VA Puget Sound Health Care System, Seattle, WA;6 and the Departments of Medicine and Epidemiology,7 University of Washington, Seattle, WA
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  • 1,2 Linda F. Fried MD, MPH,

    1. From the General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA;1 the Department of Medicine, University of California, San Francisco, CA;2 the Departments of Medicine,3 and Epidemiology,4University of Pittsburgh School of Medicine, Pittsburgh, PA; the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA;5 the Section of Nephrology, Seattle VA Puget Sound Health Care System, Seattle, WA;6 and the Departments of Medicine and Epidemiology,7 University of Washington, Seattle, WA
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  • 3,5 Catherine Stehman-Breen MD, MS,

    1. From the General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA;1 the Department of Medicine, University of California, San Francisco, CA;2 the Departments of Medicine,3 and Epidemiology,4University of Pittsburgh School of Medicine, Pittsburgh, PA; the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA;5 the Section of Nephrology, Seattle VA Puget Sound Health Care System, Seattle, WA;6 and the Departments of Medicine and Epidemiology,7 University of Washington, Seattle, WA
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  • 6,7 David Siscovick MD, MPH,

    1. From the General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA;1 the Department of Medicine, University of California, San Francisco, CA;2 the Departments of Medicine,3 and Epidemiology,4University of Pittsburgh School of Medicine, Pittsburgh, PA; the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA;5 the Section of Nephrology, Seattle VA Puget Sound Health Care System, Seattle, WA;6 and the Departments of Medicine and Epidemiology,7 University of Washington, Seattle, WA
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  • and 7 Anne B. Newman MD, MPH 3,4

    1. From the General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center, San Francisco, CA;1 the Department of Medicine, University of California, San Francisco, CA;2 the Departments of Medicine,3 and Epidemiology,4University of Pittsburgh School of Medicine, Pittsburgh, PA; the Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA;5 the Section of Nephrology, Seattle VA Puget Sound Health Care System, Seattle, WA;6 and the Departments of Medicine and Epidemiology,7 University of Washington, Seattle, WA
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Michael G. Shlipak, MD, MPH, General Internal Medicine Section, VA Medical Center (111A1), 4150 Clement Street, San Francisco, CA 94121
E-mail: shlip@itsa.ucsf.edu

Abstract

In the Cardiovascular Health Study, the authors sought to evaluate the impact of chronic renal insufficiency (CRI) on cardiovascular risk status and outcomes in a representative sample of community-dwelling elderly adults. Defined as a serum creatinine level ≥1.3 mg/dL in women and ≥1.5 mg/dL in men, CRI was present in 647 (11%) of 5808 participants. At baseline, the prevalence of clinical or subclinical cardiovascular disease was 64% in participants with CRI and 43% in those without CRI (odds ratio, 2.34; 95% confidence interval, 1.96–2.80). The incidence of cardiovascular disease events during follow-up was 3% per year in participants with creatinine levels <1.10 mg/dL and increased steadily to reach 7% per year in those with creatinine ≥1.70 mg/dL. Among the possible mediators for the association between CRI and cardiovascular morbidity are inflammatory (C-reactive protein, fibrinogen, and interleukin-6) and hemostatic (factor VII, factor VIII, plasmin-antiplasmin product, and D-dimer) biomarkers, all of which were significantly elevated in Cardiovascular Health Study participants with CRI. Future studies should evaluate the contribution of novel and traditional cardiovascular risk factors to the cardiovascular risk of elderly persons with CRI. The identification of CRI in the elderly and the use of cardiovascular prevention therapies represent a major opportunity to reduce their burden of cardiovascular morbidity.

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