title: Association of renal damage with cardiovascular diseases is independent of individual cardiovascular risk profile in hypertension: data from the Italy - Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease study.
abstract: OBJECTIVE
  In the past years, several risk charts have been created to increase the accuracy of cardiovascular risk stratification. The most widely used and validated algorithms do not included target organ damage as risk prediction. The aim of the present study was to evaluate whether preclinical renal damage is associated with cardiovascular diseases independently of individual risk profile assessed by risk charts.
  
  
  METHODS
  The study population was that of Italy-Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease, a large observational study conducted on hypertensive patients in Italy. The Framingham Risk Score (FRS), Systematic COronary Risk Estimation (SCORE) and Progetto Cuore Risk Score (Progetto Cuore RS) were computed in each eligible patient. Chronic kidney disease was defined by the presence of albuminuria or by a reduction of glomerular filtration rate.
  
  
  RESULTS
  Study participants were categorized to have low, medium and high risk according to the tertiles of the three charts. Prevalence of total cardiovascular diseases progressively and significantly increased according to the degrees of risk assessed by the three charts, the highest prevalence being in participants with a high-risk profile (both high and medium vs. low risk <0.01 for FRS, SCORE and Progetto Cuore RS). The presence of chronic kidney disease was associated with total cardiovascular diseases, independently of FRS (odds ratio 1.64, 95% confidence interval 1.33-2.02, P < 0.001), SCORE (odds ratio 1.55, 95% confidence interval 1.21-1.98, P < 0.001) and Progetto Cuore RS (odds ratio 1.59, 95% confidence interval 1.22-2.07, P < 0.001). Moreover, inclusion of renal damage in the logistic model significantly increased the accuracy of the FRS (P < 0.05), SCORE (P < 0.01) and Progetto Cuore RS (P < 0.01) to identify patients with overt cardiovascular diseases.
  
  
  CONCLUSIONS
  Identification of patients with preclinical renal damage should be encouraged in the hypertension cardiovascular risk stratification setting in order to achieve a more accurate individual risk computation. The presence of renal damage could improve cardiovascular risk prediction over the widely used risk stratification charts.
authors.affiliation: II Faculty of Medicine, University of Rome 'Sapienza', Division of Cardiology, S. Andrea Hospital, Rome, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Sciarretta
authors.forename: Valentina
authors.initials: V
authors.lastname: Valenti
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Roberto
authors.initials: R
authors.lastname: Pontremoli
authors.forename: Enrico Agabiti
authors.initials: EA
authors.lastname: Rosei
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
authors.forename: Vittorio
authors.initials: V
authors.lastname: Costa
authors.forename: Gastone
authors.initials: G
authors.lastname: Leonetti
authors.forename: Achille Cesare
authors.initials: AC
authors.lastname: Pessina
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Diana
authors.initials: D
authors.lastname: Chin
authors.forename: Francesco
authors.initials: F
authors.lastname: Paneni
authors.forename: Giacomo
authors.initials: G
authors.lastname: Deferrari
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrucci
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D055815:Young Adult