title: Malnutrition, renal dysfunction and left ventricular hypertrophy synergistically increase the long-term incidence of cardiovascular events.
abstract: Although malnutrition indicates an unfavorable prognosis in some clinical settings, the synergistic impact of nutritional state, renal dysfunction and left ventricular hypertrophy (LVH) on cardiovascular events is unknown. Among 338 patients aged 40-80 years who underwent echocardiographic evaluation between 2003 and 2005, 161 patients who were followed for >7 years were recruited. Malnutrition was defined as a geriatric nutritional risk index (GNRI) of ⩽96. The mean patient age was 63.5±9.2 years; the mean estimated glomerular filtration rate (eGFR) was 72.9±18.7 ml min(-1) per 1.73 m(2); the mean LV mass index was 114±33 g m(-)(2); and the mean GNRI was 100.4±6.0. Among the patients, 25% (n=40) had an eGFR of <60 ml min(-1) per 1.73 m(2), 29% (n=46) exhibited chronic kidney disease (CKD) and 37% (n=59) had LVH. During the follow-up period (median: 96 months), cardiovascular events were observed in 15 patients (9%). Kaplan-Meier curves showed a significantly higher incidence of cardiovascular events in patients with an eGFR of <60 ml min(-1) per 1.73 m(2) (log-rank P=0.007), a GNRI of ⩽96 (P=0.003) or LVH (P=0.010). In a Cox regression analysis, eGFR, LVH and GNRI were independent determinants of cardiovascular event incidence after adjusting for age, gender and the presence of hypertension and diabetes. Furthermore, the combination of LVH and lower GNRI was significantly associated with a higher rate of cardiovascular events not only in all patients but also in patients with CKD. In conclusion, malnutrition, low eGFR and LVH were independent determinants of cardiovascular event incidence; they synergistically increased rates of these events in the long term. The evaluation and management of LVH progression and the improvement of nutritional status are critical for preventing cardiovascular complications even in non-dialysis patients.
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Maruyama
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakagawa
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Erika
authors.initials: E
authors.lastname: Saito
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Motoki
authors.initials: M
authors.lastname: Matsuki
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Takehara
authors.affiliation: Department of Medical Laboratory and Blood Center, Asahikawa Medical University Hospital, Asahikawa, Japan.
authors.forename: Kazumi
authors.initials: K
authors.lastname: Akasaka
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hasebe
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D011379:Prognosis; D012306:Risk; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology