title: Lack of synergistic effects of metabolic syndrome and plasma fibrinogen on coronary events and mortality in moderate CKD.
abstract: BACKGROUND
  Metabolic syndrome and inflammation are interlinked in patients with moderate chronic kidney disease (CKD).
  
  
  METHODS
  We examined whether these 2 conditions exert additive or multiplicative joint effects on subsequent coronary events and death in 710 Atherosclerosis Risk in Communities Study participants with a glomerular filtration rate less than 60 mL/min/1.73 m(2) (<1.0 mL/s).
  
  
  RESULTS
  From the lowest to the highest quartile of level of plasma fibrinogen (an inflammation marker), the prevalence of metabolic syndrome (39%, 46%, 47%, and 64%; P < 0.001) increased. In multivariate Cox regression models, each 100-mg/dL increase in plasma fibrinogen level was associated with a significantly increased hazard of fatal/nonfatal coronary events (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.33 to 1.98) and death (HR, 1.49; 95% CI, 1.28 to 1.74). In the same models, metabolic syndrome also was associated with coronary events (HR, 1.49; 95% CI, 1.01 to 2.20) and death (HR, 1.40; 95% CI, 1.01 to 1.94). There was no significant interaction of plasma fibrinogen and metabolic syndrome with respect to risk of both fatal/nonfatal coronary events (P = 0.79) and death (P = 0.29). However, patients without metabolic syndrome and in the lowest quartile of plasma fibrinogen levels had the lowest incidence of fatal/nonfatal coronary events or death, whereas those with metabolic syndrome and in the highest quartile of plasma fibrinogen levels had the highest incidence of these events.
  
  
  CONCLUSIONS
  Inflammation is associated strongly with metabolic syndrome in patients with moderate CKD. Inflammation and metabolic syndrome have additive and not multiplicative joint effects on coronary events and death.
authors.affiliation: Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA.
authors.forename: Nirupama
authors.initials: N
authors.lastname: Ramkumar
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Murtaugh
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
mesh_terms: D002908:Chronic Disease; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology* / Q000378:metabolism / Q000401:mortality; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D007674:Kidney Diseases / Q000150:complications* / Q000401:mortality*; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism*; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D005340:Fibrinogen