title: Chronic kidney disease is associated with neovascularization and intraplaque hemorrhage in coronary atherosclerosis in elders: results from the Hisayama Study.
abstract: There is little information regarding whether patients with chronic kidney disease (CKD) have a high incidence of vulnerable plaques in their coronary arteries. To gain additional evidence on this, we conducted a population-based study by randomly selecting 126 subjects from 844 consecutive autopsies of elderly residents of Hisayama, Japan. We then determined the relationships of CKD with neovascularization and intraplaque hemorrhage in coronary atherosclerosis with the subjects classified into four categories based on their estimated glomerular filtration rate (eGFR). Areas of oxidized low-density lipoprotein (oxLDL) and vascular endothelial growth factor (VEGF) expression, assessed by immunohistochemistry in a total of 375 coronary arteries, increased significantly with decreasing eGFR. A lower eGFR was also associated with increased numbers of newly formed blood vessels. These relationships remained substantially unchanged after adjustment for confounding factors. The multivariate-adjusted odds ratio of the presence of intraplaque hemorrhages was 6.2 (95% confidence interval, 1.1-35.0) in patients with an eGFR <30 ml/min/1.73 m(2) compared with those with an eGFR of ≥ 60 ml/min/1.73 m(2). Thus, elderly patients with CKD have intimal neoangiogenesis and an increased risk of intraplaque hemorrhage in coronary arteries, possibly favored by local accumulation of oxLDL and VEGF.
authors.affiliation: Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. toshink@med.kyushu-u.ac.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakano
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Shinji
authors.initials: S
authors.lastname: Sumiyoshi
authors.forename: Mitsuho
authors.initials: M
authors.lastname: Onimaru
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujii
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Itabe
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Katsuo
authors.initials: K
authors.lastname: Sueishi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Tsuruya
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kiyohara
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D015415:Biomarkers / Q000032:analysis; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D003331:Coronary Vessels / Q000737:chemistry / Q000473:pathology*; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006470:Hemorrhage / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D008077:Lipoproteins, LDL / Q000032:analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008077:Lipoproteins, LDL; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; C099252:oxidized low density lipoprotein