The objective of the study was to determine whether chronic kidney disease (CKD) is
as important a risk as either diabetes mellitus (DM) or previous myocardial infarction
(MI). CKD and DM are important coronary artery disease risk factors. We hypothesized
that the risk of cardiovascular mortality in elderly patients with CKD is equivalent
to that for patients with either DM or previous MI. The CHS limited-access database
was used to identify a cohort of patients with a baseline history of MI, DM, or CKD
(estimated glomerular filtration rate <60 ml/min). Subjects were categorized in 1
of 3 groups as group 1, patients with DM (no CKD or MI); group 2, patients with previous
MI (no DM or CKD); and group 3, patients with CKD (no DM or MI). Patients were followed
up for a mean of 8.6 years, and rates of cardiovascular mortality were compared using
proportional hazards regression. There were 789, 443, and 667 people in the MI, DM,
and CKD groups, respectively. During follow-up, 124 patients (15.7%) died of cardiovascular
causes in the MI group, and 69 (15.8%) and 87 (13%), in the DM and CKD groups, respectively.
After adjusting for age, race, gender, smoking, hypertension, and total, high-density
lipoprotein, and low-density lipoprotein cholesterol, the hazard ratio (HR) for cardiovascular
mortality was similar between the DM (HR 1.0, 95% confidence interval 0.8 to 1.4))
and CKD cohorts (HR 0.8, 95% confidence interval 0.6 to 1.1) compared with the MI
group. In conclusion, the risk of cardiovascular mortality in patients with moderate
CKD was as high as that in patients with a history of MI or DM. Designation of CKD
as a cardiovascular risk equivalent in patients >65 years of age appears justified.
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Article info
Publication history
Published online: October 27, 2008
Accepted:
July 25,
2008
Received in revised form:
July 25,
2008
Received:
June 18,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
