title: Kidney disease as a risk factor for recurrent cardiovascular disease and mortality.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is highly prevalent in the United States and is an independent risk factor for adverse cardiovascular disease (CVD) and all-cause mortality outcomes in patients with acute coronary syndromes. Few studies have evaluated the effect of CKD on cardiovascular events in a diverse community-based population with underlying CVD.
  
  
  METHODS
  Data for subjects with preexisting CVD were pooled from 4 publicly available, community-based, longitudinal studies: Atherosclerosis Risk in Communities, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. CKD was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 (<1 mL/s/1.73 m2). The primary study outcome was a composite of myocardial infarction (MI), fatal coronary heart disease (CHD), stroke, and all-cause mortality. The secondary outcome included only MI and fatal CHD.
  
  
  RESULTS
  A total of 4,278 subjects satisfied inclusion criteria, and 759 subjects (17.7%) had CKD. Mean follow-up was 86 months. The primary and secondary outcomes were observed in 1,703 (39.8%) and 857 subjects (20.0%), respectively. Incidence rates for the primary and secondary outcomes were greater in persons with CKD compared with those without CKD (62.5% versus 34.9% and 30.6% versus 17.8%, respectively). Adjusted hazard ratios for the primary and secondary outcomes were 1.35 (95% confidence interval [CI], 1.21 to 1.52) and 1.32 (95% CI, 1.12 to 1.55), respectively.
  
  
  CONCLUSIONS
  The presence of CKD in a community-based population with preexisting CVD is associated with an increased risk for recurrent CVD outcomes. This increased risk persists after adjustment for traditional CVD risk factors.
authors.affiliation: Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Hocine
authors.initials: H
authors.lastname: Tighiouart
authors.forename: Paul C
authors.initials: PC
authors.lastname: Stark
authors.forename: Manish G
authors.initials: MG
authors.lastname: Amin
authors.forename: Bonnie
authors.initials: B
authors.lastname: MacLeod
authors.forename: John L
authors.initials: JL
authors.lastname: Griffith
authors.forename: Deeb N
authors.initials: DN
authors.lastname: Salem
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology