Coronary artery calcium progresses rapidly and discriminates incident cardiovascular events in chronic kidney disease regardless of diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)

Gautam R. Shroff, Otto A. Sanchez, Michael D. Miedema, Holly Kramer, Joachim H. Ix, Daniel A. Duprez, David R. Jacobs

Research output: Contribution to journalArticlepeer-review

Abstract

Background and aims: Chronic kidney disease (CKD) is associated with high prevalence of cardiovascular disease (CVD) events. We sought to assess the prognostic utility of coronary artery calcium (CAC) scores in discriminating incident CVD events among subpopulations of CKD, particularly those without diabetes mellitus (DM). Methods: Using the Multi-Ethnic Study of Atherosclerosis, we identified 4 groups based on present/absent CKD/diabetes (CKD-/DM-, n = 5308; CKD-/DM+, n = 586, CKD+/DM-, n = 620; CKD+/DM+, n = 266). Baseline and follow-up CAC (Agatston units) measurements, and association between CAC and incident CVD events in median follow-up of 13 years were evaluated using proportional hazards regression adjusting for demographics, clinical, biomarker variables. Results: Prevalence of CKD and DM in the cohort was 13% and 12.5% respectively. Annual progression in adjusted median CAC score was 24.8%, 27.9%, 26.7%, 36.8% and unadjusted cumulative incident CVD rates were 12.6%, 22.3%, 23.1%, 39.8% for CKD-/DM-, CKD-/DM+, CKD+/DM-, CKD+/DM+, respectively. After full adjustment (CKD-/DM-referent), hazard ratios (HR, 95% CI) for incident CVD events were 1.25 (1.01–1.53) CKD-/DM+, 1.10 (0.90–1.33) CKD+/DM- and 2.18 (1.73–2.76) CKD+/DM+. Using CKD-/DM-/baseline CAC = 0 referent, adjusted HRs (95% CI) for incident CVD in CKD+/DM- were 1.30 (0.81–2.07), 2.05 (1.4–2.99), and 4.15 (2.94–5.86) for baseline CAC = 0, 1–100, and >300 Agatston units respectively while for CKD+/DM+, adjusted HRs were 3.15 (2.04–4.86), 3.56 (2.26–5.62), 7.90 (5.35–11.67), respectively. Conclusions: CAC provides incremental prognostic information to predict incident CVD events in CKD regardless of DM. Moreover, baseline CAC categories discriminate incident CVD among CKD without DM, which may have implications in individualizing approach to primary prevention in this high-risk population.

Original languageEnglish (US)
Pages (from-to)75-82
Number of pages8
JournalAtherosclerosis
Volume310
DOIs
StatePublished - Oct 2020

Bibliographical note

Funding Information:
The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at www.mesa-nhlbi.org . The Multi-Ethnic Study of Atherosclerosis was supported by contracts N01-HC-95159, N01HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01 HC-95168, and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources . The authors also thank Dr. Charles Herzog for providing us valuable insights after reviewing our manuscript.

Publisher Copyright:
© 2020 Elsevier B.V.

Keywords

  • Cardiovascular disease
  • Chronic kidney disease
  • Coronary calcification
  • Diabetes

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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