title: Cardiovascular risk modification in participants with coronary disease screened by the Kidney Early Evaluation Program.
abstract: BACKGROUND
  Coronary artery disease (CAD) identifies the need for intensive treatment of risk factors among individuals with chronic kidney disease (CKD), a high-risk, complex cardiovascular risk state.
  
  
  METHODS
  An estimated glomerular filtration rate<60 mL/min/1.73 m2 or a urine albumin:creatinine ratio (ACR)≥30 mg/g (3.4 mg/mmol) defined CKD.
  
  
  RESULTS
  Of 70,454 volunteers screened the mean age was 53.5±15.7 years and 68.3% were female. A total of 5410 (7.7%) had a self-reported history of CAD; 1295 (1.8%) had a history of prior percutaneous coronary intervention (PCI); and 1124 (1.6%) had a prior history of coronary artery bypass surgery (CABG). Multivariate analysis for the outcome of suboptimal CAD risk management (composite of systolic blood pressure≥130 mmHg, glucose≥125 mg/dL (6.9 mmol/L) for diabetics, total cholesterol≥200 mg/dL (5.2 mmol/L), or current smoking; n=38,746/53,403, 72.5%) revealed older age (per year) (odds ratio (OR)=1.04, 95% confidence interval (CI) 1.03-1.04, P<0.0001), male gender (OR=1.40, 95% CI 1.34-1.47, P<0.0001), ACR≥30 mg/g (3.4 mg/mmol) (OR=1.66, 95% CI 1.55-1.79, P<0.0001), body mass index (per kg/m2) (OR=1.06, 95% CI 1.06-1.06, P<0.0001), CAD without a history of revascularization (OR=1.14, 95% CI 1.02-1.28, P=0.02) and care received by a nephrologist (OR=1.49, 95% CI 1.22-1.83, P<0.0001) were associated with worse risk factor control. Prior coronary revascularization and being under the care of a cardiologist were not associated with either improved or suboptimal risk factor control.
  
  
  CONCLUSIONS
  Chronic kidney disease is associated with overall poor rates of CAD risk factor control.
authors.affiliation: Department of Medicine, Division of Cardiology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. peteramccullough@gmail.com
authors.forename: P A
authors.initials: PA
authors.lastname: McCullough
authors.forename: A
authors.initials: A
authors.lastname: Whaley-Connell
authors.forename: W W
authors.initials: WW
authors.lastname: Brown
authors.forename: A J
authors.initials: AJ
authors.lastname: Collins
authors.forename: S-C
authors.initials: SC
authors.lastname: Chen
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.forename: K C
authors.initials: KC
authors.lastname: Norris
authors.forename: C
authors.initials: C
authors.lastname: Jurkovitz
authors.forename: S
authors.initials: S
authors.lastname: McFarlane
authors.forename: C
authors.initials: C
authors.lastname: Obialo
authors.forename: J
authors.initials: J
authors.lastname: Sowers
authors.forename: L
authors.initials: L
authors.lastname: Stevens
authors.forename: J A
authors.initials: JA
authors.lastname: Vassalotti
authors.forename: G L
authors.initials: GL
authors.lastname: Bakris
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D042241:Early Diagnosis; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis*; D007677:Kidney Function Tests / Q000379:methods / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D012307:Risk Factors; D040242:Risk Reduction Behavior