Author + information
- Received June 21, 2002
- Revision received September 12, 2002
- Accepted September 26, 2002
- Published online January 1, 2003.
- Guruprasad Manjunath, MD*,
- Hocine Tighiouart, MS†,
- Hassan Ibrahim, MD‡,
- Bonnie MacLeod, BS†,
- Deeb N Salem, MD§,
- John L Griffith, PhD†,
- Josef Coresh, MD, PhD∥,
- Andrew S Levey, MD* and
- Mark J Sarnak, MD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Mark J. Sarnak, Box 391, New England Medical Center, 750 Washington Street, Boston, Massachusetts 02111, USA.
Objectives The goal of this study was to determine whether the level of kidney function is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) outcomes in the Atherosclerosis Risk in Communities (ARIC) study, a prospective cohort study of subjects aged 45 to 64 years.
Background The level of kidney function is now recognized as a risk factor for ASCVD outcomes in patients at high risk for ASCVD, but it remains unknown whether the level of kidney function is a risk factor for ASCVD outcomes in the community.
Methods Cox proportional-hazards regression was used to evaluate the association of glomerular filtration rate (GFR) with ASCVD after adjustment for the major ASCVD risk factors in 15,350 subjects. We searched for nonlinear relationships between GFR and ASCVD.
Results During a mean follow-up time of 6.2 years, 965 (6.3%) of subjects had ASCVD events. Subjects with GFR of 15 to 59 ml/min/1.73 m2(n = 444, hazard ratio 1.38 [1.02, 1.87]) and 60 to 89 ml/min/1.73 m2(n = 7,665, hazard ratio 1.16 [1.00, 1.34]) had an increased adjusted risk of ASCVD compared with subjects with GFR of 90 to 150 ml/min/1.73 m2. Each 10 ml/min/1.73 m2lower GFR was associated with an adjusted hazard ratio of 1.05 (1.02, 1.09), 1.07 (1.01, 1.12), and 1.06 (0.99, 1.13) for ASCVD, de novo ASCVD, and recurrent ASCVD, respectively. A nonlinear model did not fit the data better than a linear model.
Conclusions The level of GFR is an independent risk factor for ASCVD and de novo ASCVD in the ARIC study.
☆ Supported by K23 NIDDK 02904-01, NIH R01 53869, and Amgen Inc., Thousand Oaks, California.
Presented, in part, at the World Congress of Nephrology 2001 in San Francisco, California, on October 14, 2001 (abstract number A-1163). The ARIC Study is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the ARIC Study Investigators. This manuscript was not prepared in collaboration with the investigators of the ARIC Study and does not necessarily reflect the opinions or views of the ARIC Study or NHLBI. Dr. Coresh is an ARIC principle investigator who contributed to this analysis initiated outside of the ARIC study.
- Received June 21, 2002.
- Revision received September 12, 2002.
- Accepted September 26, 2002.
- American College of Cardiology Foundation