title: Predictors of atherosclerotic events in patients on haemodialysis: post hoc analyses from the AURORA study.
abstract: Patients on haemodialysis (HD) are at high risk for cardiovascular events, but heart failure and sudden death are more common than atherosclerotic events. The A Study to Evaluate the Use of Rosuvastatinin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA) trial was designed to assess the effect of rosuvastatin on myocardial infarction and death from any cardiac cause in 2773 HD patients. We studied predictors of the atherosclerotic cardiovascular events in AURORA.
  
  
  
  We readjudicated all deaths and presumed myocardial infarctions according to the criteria used in the Study of Heart and Renal Protection (SHARP); these were specifically developed to separate atherosclerotic from non-atherosclerotic cardiovascular events. The readjudicated atherosclerotic end point included the first event of the following: non-fatal myocardial infarction, fatal coronary heart disease, non-fatal and fatal non-haemorrhagic stroke, coronary revascularization procedures and death from ischaemic limb disease. Stepwise Cox regression analysis was used to identify the predictors of such events.
  
  
  
  During a mean follow-up of 3.2 years, 506 patients experienced the new composite atherosclerotic outcome. Age, male sex, prevalent diabetes, prior cardiovascular disease, weekly dialysis duration, baseline albumin [hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.94-0.99 per g/L increase], high-sensitivity C-reactive protein (HR 1.13; 95% CI 1.04-1.22 per mg/L increase) and oxidized low-density lipoprotein (LDL) cholesterol (HR 1.09; 95% CI 1.03-1.17 per 10 U/L increase) were selected as significant predictors in the model. Neither LDL cholesterol nor allocation to placebo/rosuvastatin therapy predicted the outcome.
  
  
  
  Even with the use of strict criteria for end point definition, non-traditional risk factors, but not lipid disturbances, predicted atherosclerotic events in HD patients.
authors: University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK.|Section of Nephrology, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.|Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
authors: Marit D
authors: MD
authors: Solbu
authors: Department of Nephrology Ullevål, Oslo University Hospital, Oslo, Norway.
authors: Geir
authors: G
authors: Mjøen
authors: University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK.|Queen Elizabeth University Hospital Glasgow, The Renal and Transplant Unit, Glasgow, UK.
authors: Patrick B
authors: PB
authors: Mark
authors: Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
authors: Hallvard
authors: H
authors: Holdaas
authors: Division of Nephrology, Department of Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.
authors: Bengt
authors: B
authors: Fellström
authors: Department of Nephrology and Hypertension, University Hospital, Erlangen-Nürnberg, Germany.
authors: Roland E
authors: RE
authors: Schmieder
authors: Inserm, Clinical Investigation Centre 1433, Université de Lorraine and CHU, Nancy, France.
authors: Faiez
authors: F
authors: Zannad
authors: Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors: William G
authors: WG
authors: Herrington
authors: University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK.|Queen Elizabeth University Hospital Glasgow, The Renal and Transplant Unit, Glasgow, UK.
authors: Alan G
authors: AG
authors: Jardine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis*; D002097:C-Reactive Protein / Q000378:metabolism; D002784:Cholesterol / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D002097:C-Reactive Protein; D002784:Cholesterol
keywords: atherosclerosis; coronary artery disease; haemodialysis; statins; vascular calcification