title: Risk for recurrent coronary heart disease and all-cause mortality among individuals with chronic kidney disease compared with diabetes mellitus, metabolic syndrome, and cigarette smokers.
abstract: BACKGROUND
  Lipid-lowering guidelines endorse a low-density lipoprotein cholesterol goal of <100 mg/dL for people with coronary heart disease (CHD). A more stringent threshold of <70 mg/dL is recommended for those with CHD and "very high-risk" conditions such as diabetes mellitus, metabolic syndrome, or cigarette smoking. Whether chronic kidney disease (CKD) confers a similar risk for recurrent CHD events is unknown.
  
  
  RESULTS
  We evaluated the risk for recurrent CHD events and all-cause mortality among 3,938 participants ≥45 years with CHD in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Chronic kidney disease was defined by estimated glomerular filtration rate <60 mL/min per 1.73 m(2) or urinary albumin to creatinine ratio ≥30 mg/g. Participants were categorized by the presence or absence of CKD and any very high-risk condition. Over a median of 4.1 years, the crude incidence (95% CI) of recurrent CHD events were 12.1 (9.0-15.2), 18.9 (15.5-22.3), 35.0 (25.4-44.6), and 34.2 (28.2-40.3) among those without CKD or high-risk conditions; very high-risk conditions alone; and CKD alone and both CKD and very high-risk conditions. After multivariable adjustment, compared with those without CKD or very high-risk conditions, the hazard ratio (95% CI) for recurrent CHD events was 1.45 (1.02-2.05), 2.24 (1.50-3.34), and 2.10 (1.47-2.98) among those with very high-risk conditions alone, CKD alone, and both CKD and very high-risk conditions, respectively. Results were consistent for all-cause mortality.
  
  
  CONCLUSIONS
  Chronic kidney disease is associated with risk for recurrent CHD events that approximates or is larger than other established very high-risk conditions.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd., Ryals Public Health Building, Suite 230J, Birmingham, AL 35294–0022, USA.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Orlando M
authors.initials: OM
authors.lastname: Gutierrez
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.forename: David G
authors.initials: DG
authors.lastname: Warnock
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology*; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D009026:Mortality; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
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