What Is The Best Predictor of Heart Disease in CKD Patients?

by U.S. Medicine

October 3, 2014

BALTIMORE – The best indicator of the risk of heart disease in kidney disease patients appears to be calcium buildup in the coronary arteries as opposed to other risk factors, according to a new study.

The findings were reported recently in the Journal of the American Society of Nephrology (JASN).1

The report’s authors, led by Kunihiro Matsushita, MD, PhD, of Johns Hopkins Bloomberg School of Public Health and including researchers from the San Francisco VAMC, said they embarked on the investigation because some recent studies have suggested that conventional risk factors for predicting the likelihood of heart disease aren’t as useful in chronic kidney disease (CKD) patients as they are in the general population.

For the study, the researchers focused on 6,553 adults aged 45 to 84 years who did not have prior cardiovascular disease and who were participating in the Multi-Ethnic Study of Atherosclerosis. CKD had been diagnosed in 1,284 of the participants.

Over a median follow-up of 8.4 years, 650 cardiovascular events — coronary heart disease, stroke, heart failure or peripheral artery disease — occurred, 236 of the CKD patients.

Results indicated that calcium buildup in the coronary artery walls was more useful for correctly determining CKD patients’ risk of cardiovascular disease, especially coronary heart disease and heart failure, than other measures of atherosclerosis such as thickness of the carotid artery walls and narrowing of the arteries in the legs.

“Our research is important since it assures the usefulness of coronary artery calcium for better cardiovascular disease prediction in persons with CKD, a population at high risk for cardiovascular disease but with potential caveats for the use of traditional risk factors,” Matsushita said.

In fact, coronary artery calcium score performed best for the prediction of coronary heart disease and heart failure, regardless of CKD status, according to the authors, who wrote, “In conclusion, each measure improved cardiovascular risk prediction in subjects with CKD, with the greatest improvement observed with coronary artery calcium score.”

1K. Matsushita, Y. Sang, S. H. Ballew, M. Shlipak, R. Katz, S. E. Rosas, C. A. Peralta, M. Woodward, H. J. Kramer, D. R. Jacobs, M. J. Sarnak, J. Coresh. Subclinical Atherosclerosis Measures for Cardiovascular Prediction in CKD. Journal of the American Society of Nephrology, 2014; DOI: 10.1681/ASN.2014020173.

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