title: Kidney measures with diabetes and hypertension on cardiovascular disease: the Atherosclerosis Risk in Communities Study.
abstract: BACKGROUND
  Whether the association of chronic kidney disease (CKD) with cardiovascular risk differs based on diabetes mellitus (DM) and hypertension (HTN) status remains unanswered.
  
  
  METHODS
  We investigated 11,050 participants from the Atherosclerosis Risk in Communities Study (fourth examination (1996-1998)) with follow-up for cardiovascular outcomes (coronary disease, heart failure and stroke) through 2009. Using the Cox regression models, we quantified cardiovascular risk associated with estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR) in individuals with and without DM and/or HTN and assessed their interactions.
  
  
  RESULTS
  Individuals with DM and HTN generally had higher cardiovascular risk relative to those without at all the levels of eGFR and ACR. Cardiovascular risk increased with lower eGFR and higher ACR regardless of DM and HTN status (e.g. adjusted hazards ratio (HR) for eGFR 30-44 vs. 90-104 ml/min/1.73 m(2), 2.32 (95% CI, 1.66-3.26) in non-diabetics vs. 1.83 (1.25-2.67) in diabetics and 2.45 (2.20-5.01) in non-hypertensives vs. 1.51 (1.27-1.81) in hypertensives and corresponding adjusted HR for ACR 30-299 vs. <10 mg/g, 1.70 (1.45-2.00) vs. 1.34 (1.10-1.64) and 1.42 (1.10-1.85) vs. 1.57 (1.36-1.81), respectively). Only the ACR-DM interaction reached significance, with a shallower relative risk gradient among diabetics than among non-diabetics (p = 0.02). Analysis of individual cardiovascular outcomes showed similar results.
  
  
  CONCLUSIONS
  Although individuals with DM and HTN generally had higher cardiovascular risk relative to those without these complications, both low eGFR and high ACR were associated with cardiovascular diseases regardless of the presence or absence of DM and HTN. These findings reinforce the importance of CKD in cardiovascular outcomes.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md., USA.
authors.forename: Nadine
authors.initials: N
authors.lastname: Alexander
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.forename: Shoshana
authors.initials: S
authors.lastname: Ballew
authors.forename: Bakhtawar K
authors.initials: BK
authors.lastname: Mahmoodi
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
mesh_terms: D000368:Aged; D000419:Albuminuria; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology*; D003404:Creatinine / Q000097:blood / Q000652:urine; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D003404:Creatinine