Comparison of estimated glomerular filtration rates and albuminuria in predicting risk of coronary heart disease in a population with high prevalence of diabetes mellitus and renal disease.
Improved accuracy in predicting coronary heart disease (CHD) risk in patients with diabetes and kidney disease is needed. The addition of albuminuria to established methods of CHD risk calculation was reported in the Strong Heart Study (SHS) cohort. In this study, the addition of estimated glomerular filtration rate (eGFR) was evaluated using data from 4,549 American Indian SHS participants aged 45 to 74 years. After adjustment for Framingham CHD risk factors, hazard ratios for eGFR as a predictor of CHD were 1.69 (95% confidence interval 1.34 to 2.13) in women and 1.41 (95% confidence interval 0.94 to 2.13) in men. Models including albuminuria, eGFR, or both scored higher in discriminatory power than models using conventional risk factors alone in women; in men, the improvement was seen only for albuminuria and the combination of albuminuria and eGFR. Hosmer-Lemeshow assessments showed good calibration for the models using eGFR alone in both genders, followed by models including albuminuria alone in both genders. Adding eGFR improved the net reclassification improvement (NRI) in women (0.085, p = 0.0004) but not in men (0.010, p = 0.1967). NRI and integrated discrimination improvement (IDI) were improved in both genders using albuminuria and eGFR (NRI 0.135, p <0.0001, and IDI 0.027, p <0.0001 in women; NRI 0.035, p <0.0196, and IDI 0.008, p <0.0156 in men). Therefore, a risk calculator including albuminuria enhances CHD prediction compared to a calculator using only standard risk factors in men and women. Including eGFR alone improves risk prediction in women, but for men, it is preferable to include eGFR and albuminuria. In conclusion, this enhanced calculator should be useful in estimating CHD risk in populations with high prevalence of diabetes and renal disease.
MedStar Health Research Institute, Hyattsville, Maryland, USA. nawar.shara@medstar.net
Nawar M
NM
Shara
Hong
H
Wang
Eduardas
E
Valaitis
Marieta
M
Pehlivanova
Elizabeth A
EA
Carter
Helaine E
HE
Resnick
Wenyu
W
Wang
Jason G
JG
Umans
Elisa T
ET
Lee
Barbara V
BV
Howard
Richard B
RB
Devereux
Peter W F
PW
Wilson
D000368:Aged; D000419:Albuminuria / Q000652:urine*; D003327:Coronary Disease / Q000175:diagnosis*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007198:Indians, North American; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D012307:Risk Factors
Arch Intern Med. 2008 Mar 24;168(6):617-24
18362254
Arch Intern Med. 2007 Jul 9;167(13):1386-92
17620532
Circulation. 2007 Feb 20;115(7):928-35
17309939
Am J Epidemiol. 1995 Aug 1;142(3):254-68
7631630
Am J Epidemiol. 2004 May 1;159(9):882-90
15105181
J Am Soc Nephrol. 2009 May;20(5):1069-77
19357254
Radiology. 1982 Apr;143(1):29-36
7063747
JAMA. 2001 May 16;285(19):2486-97
11368702
JAMA. 2001 Jul 11;286(2):180-7
11448281
Diabetes. 1992 Oct;41 Suppl 2:4-11
1526334
Circulation. 2002 Dec 17;106(25):3143-421
12485966
Arch Intern Med. 2007 Dec 10;167(22):2490-6
18071172
Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
17569110
Diabetes Care. 1995 May;18(5):599-610
8585996
N Engl J Med. 2006 Dec 21;355(25):2615-7
17182986
Am J Epidemiol. 2008 May 15;167(10):1226-34
18385206
J Am Soc Nephrol. 2009 Aug;20(8):1813-21
19443635
Cardiovasc Diabetol. 2007 Dec 02;6:37
18053157
Tech Bull Regist Med Technol. 1960 Dec;30:207-12
13692569
Diabetes Care. 1997 Jul;20(7):1183-97
9203460
Kidney Int. 1996 Feb;49(2):557-63
8821844
J Intern Med. 2008 Oct;264(4):351-60
18522685
Am J Epidemiol. 1990 Dec;132(6):1141-55
2260546
Stat Med. 1996 Feb 28;15(4):361-87
8668867
BMJ. 2006 Jun 17;332(7555):1426
16714328
Kidney Int. 2006 Apr;69(7):1264-71
16501489
Diabetes Care. 2002 Jan;25(1):49-54
11772900
Circulation. 2006 Jun 27;113(25):2897-905
16769914
N Engl J Med. 2006 Dec 21;355(25):2631-9
17182988