title: Race/Ethnicity and Cardiovascular Outcomes in Adults With CKD: Findings From the CRIC (Chronic Renal Insufficiency Cohort) and Hispanic CRIC Studies.
abstract: BACKGROUND
  Non-Hispanic blacks and Hispanics with end-stage renal disease have a lower risk for death than non-Hispanic whites, but data for racial/ethnic variation in cardiovascular outcomes for non-dialysis-dependent chronic kidney disease are limited.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  3,785 adults with entry estimated glomerular filtration rates of 20 to 70mL/min/1.73m(2) enrolled in the CRIC (Chronic Renal Insufficiency Cohort) Study.
  
  
  METHODS
  Race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic).
  
  
  RESULTS
  Cardiovascular outcomes (atherosclerotic events [myocardial infarction, stroke, or peripheral arterial disease] and heart failure) and a composite of each cardiovascular outcome or all-cause death.
  
  
  METHODS
  Multivariable Cox proportional hazards.
  
  
  RESULTS
  During a median follow-up of 6.6 years, we observed 506 atherosclerotic events, 551 heart failure events, and 692 deaths. In regression analyses, there were no significant differences in atherosclerotic events among the 3 racial/ethnic groups. In analyses stratified by clinical site, non-Hispanic blacks had a higher risk for heart failure events (HR, 1.59; 95% CI, 1.29-1.95), which became nonsignificant after adjustment for demographic factors and baseline kidney function. In contrast, Hispanics had similar risk for heart failure events as non-Hispanic whites. In analyses stratified by clinical site, compared with non-Hispanic whites, non-Hispanic blacks were at similar risk for atherosclerotic events or death. However, after further adjustment for cardiovascular risk factors, medications, and mineral metabolism markers, non-Hispanic blacks had 17% lower risk for the outcome (HR, 0.83; 95% CI, 0.69-0.99) than non-Hispanic whites, whereas there was no significant association with Hispanic ethnicity.
  
  
  CONCLUSIONS
  Hispanics were largely recruited from a single center, and the study was underpowered to evaluate the association between Hispanic ethnicity and mortality.
  
  
  CONCLUSIONS
  There were no significant racial/ethnic differences in adjusted risk for atherosclerotic or heart failure outcomes. Future research is needed to better explain the reduced risk for atherosclerotic events or death in non-Hispanic blacks compared with non-Hispanic whites.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL. Electronic address: jplash@uic.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jason
authors.initials: J
authors.lastname: Roy
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rajat
authors.initials: R
authors.lastname: Deo
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL; Center of Complex Chronic Healthcare, Jesse Brown VA Medical Center, Chicago, IL.
authors.forename: Michael
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: John
authors.initials: J
authors.lastname: Flack
authors.affiliation: Department of Epidemiology, Tulane University, New Orleans, LA.
authors.forename: Jiang
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Medicine, Temple University, Philadelphia, PA.
authors.forename: Martin
authors.initials: M
authors.lastname: Keane
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Claudia
authors.initials: C
authors.lastname: Lora
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Akinlolu
authors.initials: A
authors.lastname: Ojo
authors.affiliation: Department of Medicine, Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Renaissance Renal Research Institute, St. John's Hospital, Detroit, MI.
authors.forename: Susan
authors.initials: S
authors.lastname: Steigerwalt
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Kaixiang
authors.initials: K
authors.lastname: Tao
authors.affiliation: Department of Medicine, Northwestern University, Chicago, IL.
authors.forename: Myles
authors.initials: M
authors.lastname: Wolf
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI.
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.affiliation: Kaiser Permanente Northern California Division of Research, Oakland, CA; Department of Epidemiology, University of California, San Francisco, San Francisco, CA; Department of Biostatistics, University of California, San Francisco, San Francisco, CA; Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D050197:Atherosclerosis / Q000209:etiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D005006:Ethnicity; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D044469:Racial Groups; D051436:Renal Insufficiency, Chronic / Q000150:complications*
keywords: CRIC (Chronic Renal Insufficiency Cohort); Hispanic; Hispanic CRIC; Race; atherosclerotic cardiovascular events; dialysis; end-stage renal disease (ESRD); ethnicity; heart failure; racial disparities; racial/ethnic variation; survival paradox