History of myocardial infarction and stroke among incident end-stage renal disease cases and population-based controls: an analysis of shared risk factors.
BACKGROUND
A history of myocardial infarction (MI) and stroke is more common among incident cases of treated end-stage renal disease (ESRD) than in the general US population.


METHODS
Whether this association is the result of shared risk factors or renal dysfunction before ESRD was examined using data from a population-based case-control study of 716 incident patients with ESRD and 361 control subjects of similar age from Maryland, Virginia, West Virginia, and Washington, DC. Medical history including a previous MI and stroke, and dates of these events were obtained by means of a structured telephone interview.


RESULTS
After adjustment for age, race, and sex, odds of ESRD were 3.6 (95% confidence interval [CI], 2.0 to 6.5) and 11.1 (95% CI, 4.3 to 28.6) times greater for those with versus without a history of MI and stroke, respectively. Adjustment for long-standing hypertension, diabetes mellitus, and several other potential confounders reduced the odds ratio (OR) of ESRD for those with a history of MI by 77% (OR, 1.6; 95% CI, 0.7 to 3.3) and 39% (OR, 7.2; 95% CI, 2.2 to 23.2) for those with a history of stroke. The OR for ESRD was higher within 5 years of an MI (OR, 2.2; 95% CI, 0.8 to 6.1) or stroke (OR, 14.9; 95% CI, 1.8 to 125) than for more distant MI (OR, 0.8; 95% CI, 0.2 to 2.5) and stroke (OR, 4.5; 95% CI, 1.0 to 19.0) events.


CONCLUSIONS
The high prevalence of a history of MI at ESRD incidence is explained primarily by shared risk factors, but the high prevalence of stroke is not.
Muntner
Paul
P
Department of Epidemiology, Tulane University Health Sciences Center, New Orleans, LA 70112, USA. pmuntner@tulane.edu
Coresh
Josef
J
Klag
Michael J
MJ
Whelton
Paul K
PK
Perneger
Thomas V
TV
D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D002908:Chronic Disease; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D007674:Kidney Diseases / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*; D014768:Virginia / Q000453:epidemiology; D014903:West Virginia / Q000453:epidemiology