title: Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome.
abstract: OBJECTIVE
  Chronic kidney disease is associated with a higher risk of cardiovascular outcomes. The prognostic significance of worsening renal function has also been shown in various cohorts of cardiac disease; however, the predictors of worsening renal function and the contribution of inflammation remains to be established.
  
  
  METHODS
  Worsening renal function was defined as a 25% or more decrease in estimated GFR (eGFR) over a 1-mo period in patients after a non-ST or ST elevation acute coronary syndromes participating in the Aggrastat-to-Zocor Trial; this occurred in 5% of the 3795 participants.
  
  
  RESULTS
  A baseline C-reactive protein (CRP) in the fourth quartile was a significant predictor of developing worsening renal function (odds ratio, 2.48; 95% confidence interval, 1.49, 4.14). After adjusting for baseline CRP and eGFR, worsening renal function remained a strong multivariate predictor for the combined cardiovascular composite of CV death, recurrent myocardial infarction (MI), heart failure or stroke (hazard ratio, 1.6; 95% confidence interval, 1.1, 2.3).
  
  
  CONCLUSIONS
  Patients with an early decline in renal function after an acute coronary syndrome are at a significant increased risk for recurrent cardiovascular events. CRP is an independent predictor for subsequent decline in renal function and reinforces the idea that inflammation may be related to the pathophysiology of progressive renal disease.
authors.affiliation: University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada. lmielniczuk@ottawaheart.ca
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mielniczuk
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Eldrin F
authors.initials: EF
authors.lastname: Lewis
authors.forename: Michael A
authors.initials: MA
authors.lastname: Blazing
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.forename: Satishkumar
authors.initials: S
authors.lastname: Mohanavelu
authors.forename: Jean
authors.initials: J
authors.lastname: Rouleau
authors.forename: Keith
authors.initials: K
authors.lastname: Fox
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000401:mortality*; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000175:diagnosis / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D000960:Hypolipidemic Agents; D002097:C-Reactive Protein; D019821:Simvastatin