title: Subclinical atherosclerosis measures for cardiovascular prediction in CKD.
abstract: Whether inclusion of the coronary artery calcium score improves cardiovascular risk prediction in individuals with CKD, a population with unique calcium-phosphate homeostasis, is unknown. Among 6553 participants ages 45-84 years without prior cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis, coronary artery calcium score was assessed for cardiovascular risk prediction beyond the Framingham predictors in those with (n=1284) and without CKD and contrasted with carotid intima-media thickness and ankle-brachial index (two other measures of subclinical atherosclerosis). During a median follow-up of 8.4 years, 650 cardiovascular events (coronary heart disease, stroke, heart failure, and peripheral artery disease) occurred (236 events in subjects with CKD). In Cox proportional hazards models adjusted for Framingham predictors, each subclinical measure was independently associated with cardiovascular outcomes, with larger adjusted hazard ratios (HRs; per 1 SD) for coronary artery calcium score than carotid intima-media thickness or ankle-brachial index in subjects without and with CKD (HR, 1.69; 95% confidence interval [95% CI], 1.45 to 1.97 versus HR, 1.12; 95% CI, 1.00 to 1.25 and HR, 1.20; 95% CI, 1.08 to 1.32, respectively). Compared with inclusion of carotid intima-media thickness or ankle-brachial index, inclusion of the coronary artery calcium score led to greater increases in C statistic for predicting cardiovascular disease and net reclassification improvement. Coronary artery calcium score performed best for the prediction of coronary heart disease and heart failure, regardless of CKD status. In conclusion, each measure improved cardiovascular risk prediction in subjects with CKD, with the greatest improvement observed with coronary artery calcium score.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; kmatsush@jhsph.edu.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California; Departments of Medicine, Epidemiology, and Biostatistics and.
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, Washington;
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
authors.forename: Sylvia E
authors.initials: SE
authors.lastname: Rosas
authors.affiliation: Division of Nephrology, University of California, San Francisco, California; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California;
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Division of Nephrology, Loyola University Medical Center, Maywood, Illinois;
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Kramer
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; and.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D002118:Calcium / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism; D003327:Coronary Disease / Q000453:epidemiology / Q000378:metabolism; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000378:metabolism; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000378:metabolism
chemical_list: D002118:Calcium
keywords: CKD; arteriosclerosis; cardiovascular disease; coronary calcification