title: Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community.
abstract: OBJECTIVE
  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 m(2) (n = 444, hazard ratio 1.38 [1.02, 1.87]) and 60 to 89 ml/min/1.73 m(2) (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 m(2). Each 10 ml/min/1.73 m(2) lower 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.
authors.affiliation: Division of Nephrology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
authors.forename: Guruprasad
authors.initials: G
authors.lastname: Manjunath
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Hassan
authors.initials: H
authors.lastname: Ibrahim
authors.forename: Bonnie
authors.initials: B
authors.lastname: MacLeod
authors.forename: Deeb N
authors.initials: DN
authors.lastname: Salem
authors.forename: John L
authors.initials: JL
authors.lastname: Griffith
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D001161:Arteriosclerosis / Q000453:epidemiology* / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis