title: Carotid atherosclerotic disease predicts cardiovascular events in hemodialysis patients: a prospective study.
abstract: BACKGROUND
  To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients.
  
  
  METHODS
  Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT <0.9 mm, 2) IMT >0.9 mm, 3) carotid plaque with stenosis <50% and 4) plaque with stenosis >50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed.
  
  
  RESULTS
  83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02).
  
  
  CONCLUSIONS
  The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies.
authors.affiliation: Nephrology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Sílvia
authors.initials: S
authors.lastname: Collado
authors.affiliation: Nephrology Department, Fundació Puigvert, Barcelona, Spain.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Coll
authors.affiliation: Radiology Department, Hospital Clínic, Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Nicolau
authors.affiliation: CETIRSA Barcelona, Fresenius Medical Care, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Pons
authors.affiliation: Institut Hemodiàlisi Barcelona, Diaverum, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Cruzado
authors.affiliation: Nephrology Department, Hospital del Mar, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.affiliation: Nephrology Department, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain.
authors.forename: Aleix
authors.initials: A
authors.lastname: Cases
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis