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CAC score predicted CV risk in patients with chronic kidney disease
Inclusion of the coronary artery calcium score improved CV risk prediction in patients with chronic kidney disease.
Carotid intima-media thickness and ankle-brachial index also improved CV risk prediction in that population, but not as much as coronary artery calcium (CAC) score, researchers reported in the Journal of the American Society of Nephrology.
Kunihiro Matsushita, MD, PhD, from the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues studied 6,553 participants (19.6% with CKD) from the Multi-Ethnic Study of Atherosclerosis aged 45 to 84 years with no history of CVD.
They assessed CAC score, carotid intima-media thickness and ankle-brachial index for CV risk prediction beyond the Framingham CV risk predictors.
The researchers observed 650 CV events (236 in those with CKD) during a median follow-up period of 8.4 years. CV events were defined as CHD, stroke, HF and peripheral artery disease.
In models adjusted for the Framingham predictors, each of the three measures was independently associated with CV events in participants with and without CKD.
However, the adjusted HR for CAC score (HR for those with CKD=1.69; 95% CI, 1.45-1.97; HR for those without CKD=1.89; 95% CI, 1.69-2.12) was larger than that for carotid intima-media thickness (HR for those with CKD=1.12; 95% CI, 1-1.25; HR for those without CKD=1.19; 95% CI, 1.08-1.31) and ankle-brachial index (HR for those with CKD=1.2; 95% CI, 1.08-1.32; HR for those without CKD=1.27; 95% CI, 1.16-1.4).
In individuals with or without CKD, the C-statistics for CVD prediction and net reclassification improvement significantly improved when the CAC score was added to the risk-prediction model, but the same was not true for carotid intima-media thickness and ankle-brachial index, according to the researchers.
CAC score was best at predicting CHD and HF, ankle-brachial index was best at predicting PAD, and little improvement in prediction for stroke occurred with any of the three measures, the researchers wrote.
“Our research is important since it assures the usefulness of coronary artery calcium for better [CVD] prediction in persons with CKD, a population at high risk for [CVD] but with potential caveats for the use of traditional risk factors,” Masushita said in a press release.
Disclosure: The study was funded by the NHLBI and the National Center for Research. The researchers report no relevant financial disclosures.