title: Cigarette smoking and cardio-renal events in patients with atherosclerotic renal artery stenosis.
abstract: Cigarette smoking causes cardiovascular disease and is associated with poor kidney function in individuals with diabetes mellitus and primary kidney diseases. However, the association of smoking on patients with atherosclerotic renal artery stenosis has not been studied. The current study utilized data from the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL, NCT00081731) clinical trial to evaluate the effects of smoking on the risk of cardio-renal events and kidney function in this population. Baseline data showed that smokers (n = 277 out of 931) were significantly younger at enrollment than non-smokers (63.3±9.1 years vs 72.4±7.8 years; p<0.001). In addition, patients who smoke were also more likely to have bilateral renal artery stenoses and peripheral vascular disease (PVD). Longitudinal analysis showed that smokers experienced composite endpoint events (defined as first occurrence of: stroke; cardiovascular or renal death; myocardial infarction; hospitalization for congestive heart failure; permanent renal replacement; and progressive renal insufficiency defined as 30% reduction of GFR from baseline sustained for ≥ 60 days) at a substantially younger age compared to non-smokers (67.1±9.0 versus 76.1±7.9, p<0.001). Using linear regression and generalized linear modeling analysis controlled by age, sex, and ethnicity, smokers had significantly higher cystatin C levels (1.3±0.7 vs 1.2±0.9, p<0.01) whereas creatinine and estimated glomerular filtration rate (eGFR) were not different from non-smokers. From these data we conclude that smoking has a significant association with deleterious cardio-renal outcomes in patients with renovascular hypertension.
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Drummond
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Brewster
authors.affiliation: Department of Mathematics, University of Toledo, Toledo, OH, United States of America.
authors.forename: Wencan
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Mathematics, University of Toledo, Toledo, OH, United States of America.
authors.forename: Kaili
authors.initials: K
authors.lastname: Ren
authors.affiliation: Department of Mathematics, University of Toledo, Toledo, OH, United States of America.
authors.forename: Yanmei
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Division of Nephrology, University of Washington School of Medicine, Providence Health Care, Spokane, WA, United States of America.
authors.forename: Katherine R
authors.initials: KR
authors.lastname: Tuttle
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America.
authors.forename: Steven T
authors.initials: ST
authors.lastname: Haller
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI, United States of America.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Jamerson
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America.
authors.forename: Lance D
authors.initials: LD
authors.lastname: Dworkin
authors.affiliation: Harvard Clinical Research Institute, Boston, MA, United States of America.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.affiliation: Departments of Medicine and Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, United States of America.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Murphy
authors.affiliation: Harvard Clinical Research Institute, Boston, MA, United States of America.
authors.forename: Ralph B
authors.initials: RB
authors.lastname: D'Agostino
authors.affiliation: University of Texas Health Science Center, San Antonio TX, United States of America.
authors.forename: William L
authors.initials: WL
authors.lastname: Henrich
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America.
authors.forename: Jiang
authors.initials: J
authors.lastname: Tian
authors.affiliation: Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States of America.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.affiliation: Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States of America.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D012078:Renal Artery Obstruction / Q000150:complications* / Q000503:physiopathology; D012907:Smoking; D014026:Nicotiana