Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease.
Coronary artery calcification (CAC) is highly prevalent in dialysis-naive patients with chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease and all-cause mortality in this population.



To study the prospective association of CAC with risk of cardiovascular disease and all-cause mortality among dialysis-naive patients with CKD.



The prospective Chronic Renal Insufficiency Cohort study recruited adults with an estimated glomerular filtration rate of 20 to 70 mL/min/1.73 m2 from 7 clinical centers in the United States. There were 1541 participants without cardiovascular disease at baseline who had CAC scores.



Coronary artery calcification was assessed using electron-beam or multidetector computed tomography.



Incidence of cardiovascular disease (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every 6 months and confirmed by medical record adjudication.



During an average follow-up of 5.9 years in 1541 participants aged 21 to 74 years, there were 188 cardiovascular disease events (60 cases of myocardial infarction, 120 heart failures, and 27 strokes; patients may have had >1 event) and 137 all-cause deaths. In Cox proportional hazards models adjusted for age, sex, race, clinical site, education level, physical activity, total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, use of antihypertensive treatment, current cigarette smoking, diabetes status, body mass index, C-reactive protein level, hemoglobin A1c level, phosphorus level, troponin T level, log N-terminal pro-B-type natriuretic peptide level, fibroblast growth factor 23 level, estimated glomerular filtration rate, and proteinuria, the hazard ratios associated with per 1 SD log of CAC were 1.40 (95% CI, 1.16-1.69; P < .001) for cardiovascular disease, 1.44 (95% CI, 1.02-2.02; P = .04) for myocardial infarction, 1.39 (95% CI, 1.10-1.76; P = .006) for heart failure, and 1.19 (95% CI, 0.94-1.51; P = .15) for all-cause mortality. In addition, inclusion of CAC score led to an increase in the C statistic of 0.02 (95% CI, 0-0.09; P < .001) for predicting cardiovascular disease over use of all the above-mentioned established and novel cardiovascular disease risk factors.



Coronary artery calcification is independently and significantly related to the risks of cardiovascular disease, myocardial infarction, and heart failure in patients with CKD. In addition, CAC improves risk prediction for cardiovascular disease, myocardial infarction, and heart failure over use of established and novel cardiovascular disease risk factors among patients with CKD; however, the changes in the C statistic are small.
Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana2Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
Jing
J
Chen
LA BioMed at Harbor-UCLA Medical Center, Los Angeles, California.
Matthew J
MJ
Budoff
Department of Medicine, Division of Cardiology, Columbia University, New York, New York.
Muredach P
MP
Reilly
Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia.
Wei
W
Yang
Joslyn Diabetic Center, Harvard Medical School, Boston, Massachusetts.
Sylvia E
SE
Rosas
Department of Medicine, University Hospitals of Case Western Reserve University, Cleveland, Ohio.
Mahboob
M
Rahman
Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia.
Xiaoming
X
Zhang
Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia.
Jason A
JA
Roy
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
Eva
E
Lustigova
Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia.
Lisa
L
Nessel
Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia.
Virginia
V
Ford
Department of Medicine, School of Medicine, George Washington University, Washington, DC.
Dominic
D
Raj
Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago.
Anna C
AC
Porter
Department of Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Elsayed Z
EZ
Soliman
Department of Medicine, University Hospitals of Case Western Reserve University, Cleveland, Ohio.
Jackson T
JT
Wright
Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.
Myles
M
Wolf
Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana2Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
Jiang
J
He
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult