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CAC associated with CVD risk in chronic kidney disease
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Among adults with chronic kidney disease, coronary artery calcification was significantly and independently associated with CVD, MI, HF and all-cause mortality, according to findings published in JAMA Cardiology.
“Coronary artery calcification independently predicts the risk [for CHD] and total [CVD] more than traditional risk factors in the general population,” Jing Chen, MD, MSc, of Tulane University School of Medicine, New Orleans, and of the School of Public Health and Tropical Medicine at Tulane University, and colleagues wrote in the study background. “However, there are sparse data available from dialysis-naive patients with [chronic kidney disease] and it is uncertain whether CAC score confers an elevated risk of [CVD] morbidity and mortality in such patients.”
The study participants (n = 1,541; aged 21 to 74 years) had mild to moderate chronic kidney disease (age-based estimated glomerular filtration rate, 20 to 70 mL/min/1.73 m2) and were dialysis-naive. Electron-beam or multidetector CT was performed on all participants.
During follow-up (mean, 5.9 years), there were 188 CVD events (60 MI events, 120 HF events and 27 strokes) and 137 all-cause deaths.
CAC score was associated with CVD (HR = 1.4 per 1 standard deviation [SD] log; 95% CI, 1.16-1.69), MI (HR = 1.44 per 1 SD log; 95% CI, 1.02-2.02) and HF (HR = 1.39 per 1 SD log; 95% CI, 1.1-1.76), with a trend toward association with all-cause mortality (HR = 1.19 per 1 SD log; 95% CI, 0.94-1.51) after adjustment for 21 CVD risk factors.
Additionally, inclusion of CAC scores improved risk prediction for CVD with an increase in the C statistic of 0.02 (95% CI, 0-0.09) above established and novel risk factors.
“Plaque assessment by coronary CT angiography has shown some promise in predicting [CVD] outcomes among patients with [chronic kidney disease],” the researchers wrote. “In our study, inclusion of CAC score in the prediction models led to a significant increase in the C statistic and positive net reclassification improvement and integrated discrimination improvement over use of [American College of Cardiology/American Heart Association] atherosclerotic [CVD] risk factors and other novel risk factors. These findings suggest that CAC could be used for risk stratification and prediction among patients with [chronic kidney disease].” – by Cassie Homer
Disclosure: Chen reports no relevant financial disclosures. Please see the full study for a list of the other researchers’ relevant financial disclosures.
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