Renovascular disease and the risk of adverse coronary events in the elderly: a prospective, population-based study.
BACKGROUND
Renovascular disease is a cause of secondary hypertension and renal insufficiency and is suspected to contribute to morbidity and mortality of coronary heart disease. This investigation prospectively examined associations between renovascular disease and adverse coronary events among a population-based sample of elderly Americans.


METHODS
The Cardiovascular Health Study is a prospective, multicenter cohort study of cardiovascular disease risk factors, morbidity, and mortality among Americans older than 65 years. Renal duplex sonography was performed on 870 individuals between January 1995 and February 1997. Renovascular disease was defined as any focal peak systolic velocity of 1.8 m/s or greater (renal artery stenosis) or the absence of a Doppler-shifted signal from an imaged artery (renal artery occlusion). Adverse coronary events were defined as hospitalized angina, fatal or nonfatal myocardial infarction, and coronary revascularization.


RESULTS
During a mean follow-up of 14 months, 68 participants experienced incident or recurrent adverse coronary events. The presence of renovascular disease demonstrated a significant relationship with adverse coronary events (hazard ratio, 1.96; 95% confidence interval, 1.00-3.83; P = .05) that remained after controlling for the effects of coexisting atherosclerotic risk factors and prevalent cardiovascular disease. The relationship between renovascular disease and adverse coronary events was not dependent on the effects of increased blood pressure.


CONCLUSIONS
The presence of renovascular disease was associated with an increase in the risk of adverse coronary events in this sample. The increment in risk was not dependent on the effects of associated atherosclerotic risk factors, other prevalent cardiovascular disease, or increased blood pressure.
Edwards
Matthew S
MS
Section on Vascular Surgery, Division of Surgical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1095, USA.
Craven
Timothy E
TE
Burke
Gregory L
GL
Dean
Richard H
RH
Hansen
Kimberley J
KJ
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006334:Heart Function Tests; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D018608:Ultrasonography, Doppler; D014481:United States / Q000453:epidemiology