Renal function and cardiovascular mortality in elderly men: the role of inflammatory, procoagulant, and endothelial biomarkers.
OBJECTIVE
To assess the extent to which inflammatory, procoagulant, and endothelial biomarkers modify the relationship between diminished renal function and cardiovascular mortality.


RESULTS
Prospective study of 4029 men aged 60-79 years followed up for a mean period of 6 years, during which 304 cardiovascular deaths occurred. Predicted estimated glomerular filtration rate (eGFR) was used as a measure of renal function. Reduced eGFR was associated with increased prevalence of established cardiovascular risk factors [cardiovascular disease, diabetes, hypertension, left ventricular (LV) hypertrophy, and dyslipidaemia] and higher levels of inflammatory markers [interleukin 6 (IL-6), C-reactive protein], endothelial markers [von Willebrand factor (vWF) and tissue plasminogen activator], activated coagulation markers (fibrin D-dimer), and blood viscosity. Cardiovascular mortality risk increased with decreasing levels of eGFR, particularly among men with eGFR <60 mL/min per 1.73 m(2) even after adjustment for established risk factors (adjusted RR 1.49, 95% CI 1.10, 2.03; <60 vs. > or =70 mL/min per 1.73 m(2)). The association was attenuated after further adjustment for vWF, D-dimer, and IL-6 (adjusted RR 1.34, 95% CI 0.98-1.82).


CONCLUSIONS
Mild-to-moderate renal insufficiency is associated with significantly increased cardiovascular mortality in elderly men, which is partly explained by the increased prevalence of established risk factors, markers of coagulation, endothelium, and inflammation.
Wannamethee
Sasiwarang Goya
SG
Department of Primary Care and Population Sciences, Royal Free and, University College Medical School, Rowland Hill Street, London NW3 2PF, UK. goya@pcps.ucl.ac.uk
Shaper
A Gerald
AG
Lowe
Gordon D O
GD
Lennon
Lucy
L
Rumley
Ann
A
Whincup
Peter H
PH
D000368:Aged; D015415:Biomarkers; D001778:Blood Coagulation Disorders / Q000401:mortality / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014657:Vasculitis
D015415:Biomarkers