Worsening kidney function ups ASCVD risk

Stephen Padilla
05 Sep 2023
Stopping RAS inhibitors does not slow eGFR decline in advanced CKD

Individuals with worsening kidney function are at greater risk of future atherosclerotic cardiovascular diseases (ASCVD), and such risk is more evident among women, according to a study.

“Using estimated glomerular filtration rate (eGFR) as part of risk assessment can inform targeting early interventions to prevent both kidney disease and subsequent ASCVD, especially in the era where effective pharmacotherapy such as SGLT2-Inhibitors have demonstrated renal and cardioprotective effects in high-risk populations,” said the researchers.

Lead researcher Dr Jamal Rana of Kaiser Permanente Oakland Medical Centre, Oakland, US, presented the findings of their study at the recent ESC Congress 2023 in Amsterdam, the Netherlands.

Rana and colleagues conducted this observational cohort study to assess the impact of kidney function on future ASCVD risk among adults (aged 30‒55 years) without established ASCVD (as of 1 January 2006) who were members of an integrated healthcare delivery system in Northern Carolina.

Risk ratios (RRs) for incident ASCVD events by kidney function (eGFR mL/min/1.73 m2) were estimated using multivariate models adjusted for age, sex, race, diabetes, hypertension, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, albuminuria, and smoking.

The researchers defined incident ASCVD events as a composite of nonfatal myocardial infarction, ischaemic stroke, or coronary heart disease through 31 December 2020.

Overall, 426,735 individuals (mean age 45.4 years) were included in the study, of whom 55 percent were women. The median follow-up was 12.7 years. [Rana J, et al, ESC Congress 2023]

Fully adjusted models showed RRs for future ASCVD of 1.7 (95 percent confidence interval [CI], 1.5‒1.9) for patients with eGFR 30‒59 mL/min/1.73 m2 and 2.2 (95 percent CI, 1.8‒2.7) for those with eGFR <30 mL/min/1.73 m2 compared with participants with eGFR ≥60 mL/min/1.73 m2.

Notably, the association between kidney function and ASCVD was similar by sex for eGFR 30‒59 mL/min/1.73 m2, but the risk was increased among women with eGFR <30 mL/min/1.73 m2.

ARIC Study

These findings support those of the Atherosclerosis Risk in Communities (ARIC) study, which found that the level of eGFR was an independent risk factor for ASCVD. [J Am Coll Cardiol 2003;41:47-55]

In the ARIC study, 965 out of 15,350 participants (6.3 percent) had ASCVD events during a mean follow-up of 6.2 years. ASCVD risk was increased among individuals with eGFR 15‒59 mL/min/1.72 m2 (n=444; hazard ratio [HR], 1.38, 95 percent CI, 1.02‒1.87) and eGFR 60‒89 mL/min/1.73 m2 (n=7,665; HR, 1.16, 95 percent CI, 1.00‒1.34) compared with those with eGFR 90‒150 mL/min/1.73 m2. [J Am Coll Cardiol 2003;41:47-55]

In addition, each 10 mL/min/1.73 m2 reduction in eGFR resulted in an increased risk for ASCVD (adjusted HR, 1.05, 95 percent CI, 1.02‒1.09), de novo ASCVD (adjusted HR, 1.07, 95 percent CI, 1.01‒1.12), and recurrent ASCVD (adjusted HR, 1.06, 95 percent CI, 0.99‒1.13). [J Am Coll Cardiol 2003;41:47-55]

“A nonlinear model did not fit the data better than a linear model,” the authors said.

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