Author + information
- Senthil Selvaraj,
- Sanjiv Shah,
- Mark Ommerborn,
- Cheryl Clark,
- Michael Hall,
- Robert Mentz,
- Saadia Qazi,
- Jeremy Robbins,
- Jiaying Chen,
- Thomas Skelton,
- J. Michael Gaziano and
- Luc Djousse
Background: African Americans (AA) develop chronic kidney disease (CKD) and pulmonary hypertension (PH) at disproportionately high rates. It is unknown whether PH heightens the risk of heart failure (HF) admission or mortality among CKD patients, including non-end stage disease.
Methods: We analyzed AA patients with CKD (eGFR<60 or urine albumin/creatinine >30 mg/g) and available echocardiographic pulmonary artery systolic pressure (PASP) from the Jackson Heart Study (N=408). We used Cox proportional hazards models to determine whether PH (PASP>35 mmHg) was associated with higher rates of HF hospitalization and mortality. In cross-sectional analysis, we examined the relationship between cystatin C and PASP and potential mediators.
Results: Mean age was 63±13 years, 70% were female, 78% had hypertension, and 22% had PH. After adjusting for several confounders, including BNP, PH was independently associated with HF hospitalization (HR 2.47, 95% CI: 1.11-5.49), mortality (HR 1.58, 95% CI: 1.00, 2.51), and the combined outcome (HR 1.99, CI: 1.15-3.44) (see Fig). Excluding patients on hemodialysis or with prevalent HF yielded similar results. Log cystatin C was directly associated with PASP (adjusted β=2.4 [95% CI 0.8, 4.1] per standard deviation change in cystatin C). Mediation analysis showed that BNP and endothelin-1 explained 56% and 40%, respectively, of the indirect effects.
Conclusions: Among AA with CKD, PH was independently associated with a higher risk of HF admission and mortality.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Predicting the Future: Observations and Discoveries From Registries and Databases
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1230-002
- 2017 American College of Cardiology Foundation