Cardiovascular disease risk status in elderly persons with renal insufficiency.
BACKGROUND
Renal insufficiency has been independently associated with incident cardiovascular disease events in some, but not all, prospective studies. We determined the prevalence of elevated cardiovascular disease risk status among elderly persons with renal insufficiency.


METHODS
This study is a cross-sectional analysis using data collected at the baseline visit of the Cardiovascular Health Study, which enrolled 5888 community dwelling adults aged 65 years or older from four clinical centers in the United States. Renal insufficiency was defined as a serum creatinine level > or =1.3 mg/dL in women and > or =1.5 mg/dL in men. The outcomes of this study included prevalent cardiovascular disease [prior coronary heart disease (CHD) or stroke], subclinical cardiovascular disease (abnormal values of ankle-arm index, carotid ultrasound, and echocardiography) and elevated cardiovascular risk based upon a diagnosis of diabetes and the Framingham equations. The association between renal insufficiency and cardiovascular risk status was estimated with and without adjustment for other cardiovascular predictors.


RESULTS
Among the 5808 participants with creatinine levels measured at entry, 15.9% of men (N = 394), and 7.6% of women (N = 254) had renal insufficiency. The prevalence of either clinical or subclinical cardiovascular disease was 64% in persons with renal insufficiency compared with 43% in those without it [odds ratio (OR) 2.34; 95% confidence interval (95% CI), 1.96, 2.80]. After adjustment for other cardiovascular risk factors, renal insufficiency remained significantly associated with clinical and subclinical cardiovascular disease (adjusted OR 1.43; 95% CI, 1.18, 1.75), but the magnitude of association was substantially reduced. After combining clinical and subclinical cardiovascular disease, diabetes, and an estimated risk>20% by the Framingham equations, 78% of men and 61% of women with renal insufficiency had elevated cardiovascular risk status.


CONCLUSIONS
Renal insufficiency is a marker for elevated cardiovascular disease risk in community dwelling elderly adults.
Shlipak
Michael G
MG
General Internal Medicine Section, Medical Service, Veterans Affairs Medical Center (111A1), 4150 Clement Street, San Francisco, CA 94121, USA. shlip@itsa.ucsf.edu
Fried
Linda F
LF
Crump
Casey
C
Bleyer
Anthony J
AJ
Manolio
Teri A
TA
Tracy
Russell P
RP
Furberg
Curt D
CD
Psaty
Bruce M
BM
D017677:Age Distribution; D000368:Aged; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D003404:Creatinine