Yoshihiro Hirata1, Seigo Sugiyama2, Eiichiro Yamamoto1, Yasushi Matsuzawa3, Eiichi Akiyama4, Hiroaki Kusaka1, Koichiro Fujisue1, Hirofumi Kurokawa1, Junichi Matsubara1, Koichi Sugamura1, Hirofumi Maeda1, Satomi Iwashita1, Hideaki Jinnouchi5, Kunihiko Matsui6, Hisao Ogawa1. 1. Faculty of Life Sciences, Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University Kumamoto, Japan. 2. Faculty of Life Sciences, Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University Kumamoto, Japan; Cardiovascular Division Diabetes Care Center, Jinnouchi Hospital Kumamoto, Japan. Electronic address: ssugiyam@kumamoto-u.ac.jp. 3. Division of Cardiology, Yokohama City University Medical Center Yokohama, Japan. 4. Faculty of Life Sciences, Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University Kumamoto, Japan; Division of Cardiology, Yokohama City University Medical Center Yokohama, Japan. 5. Diabetes Care Center, Jinnouchi Hospital Kumamoto, Japan; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Kumamoto University Hospital Kumamoto, Japan. 6. Department of General Internal Medicine, Yamaguchi University Hospital Ube, Japan.
Abstract
BACKGROUND: As patients with chronic kidney disease (CKD) are at high risk of developing coronary artery disease (CAD), it is important to stratify their cardiovascular risk. We investigated whether peripheral endothelial dysfunction is associated with the presence of CAD in patients with CKD and is a predictor of cardiovascular events. METHODS: We enrolled 383 CKD patients with at least one coronary risk factor. Peripheral endothelial function was assessed by reactive hyperemia peripheral arterial tonometry index (RHI). The presence of CAD was determined by coronary angiography. Cardiovascular events were assessed during follow-up. RESULTS: Ln-RHI was significantly lower in risk factor-matched CKD patients (n=323) than risk factor-matched non-CKD patients (n=323) (0.527 ± 0.192 vs. 0.580 ± 0.218, p=0.001). In CKD patients (n=383), Ln-RHI was significantly lower in CAD (0.499 ± 0.183, n=262) than non-CAD (0.582 ± 0.206, n=121) (p<0.001) patients. Multivariate logistic regression analysis identified Ln-RHI as an independent factor associated with the presence of CAD (p=0.001). During a mean follow-up period of 30 months, 90 cardiovascular events were recorded in CKD patients. Multivariate Cox hazard analysis identified low-Ln-RHI as an independent predictor of cardiovascular events (hazard ratio=2.70, 95% confidence interval=1.62-4.51, p<0.001). The predictive value of combined Ln-RHI and Framingham risk score (FRS) was evaluated by net reclassification index (NRI) and C-statistics, which showed significant improvement (NRI=22%, p<0.001) (C-statistics: FRS=0.49, FRS+Ln-RHI=0.62, p=0.005). CONCLUSIONS: Endothelial function was significantly impaired in CKD patients and correlated with the presence of CAD. Severe endothelial dysfunction was an independent and incremental predictor of cardiovascular events in CKD.
BACKGROUND: As patients with chronic kidney disease (CKD) are at high risk of developing coronary artery disease (CAD), it is important to stratify their cardiovascular risk. We investigated whether peripheral endothelial dysfunction is associated with the presence of CAD in patients with CKD and is a predictor of cardiovascular events. METHODS: We enrolled 383 CKDpatients with at least one coronary risk factor. Peripheral endothelial function was assessed by reactive hyperemia peripheral arterial tonometry index (RHI). The presence of CAD was determined by coronary angiography. Cardiovascular events were assessed during follow-up. RESULTS: Ln-RHI was significantly lower in risk factor-matched CKDpatients (n=323) than risk factor-matched non-CKDpatients (n=323) (0.527 ± 0.192 vs. 0.580 ± 0.218, p=0.001). In CKDpatients (n=383), Ln-RHI was significantly lower in CAD (0.499 ± 0.183, n=262) than non-CAD (0.582 ± 0.206, n=121) (p<0.001) patients. Multivariate logistic regression analysis identified Ln-RHI as an independent factor associated with the presence of CAD (p=0.001). During a mean follow-up period of 30 months, 90 cardiovascular events were recorded in CKDpatients. Multivariate Cox hazard analysis identified low-Ln-RHI as an independent predictor of cardiovascular events (hazard ratio=2.70, 95% confidence interval=1.62-4.51, p<0.001). The predictive value of combined Ln-RHI and Framingham risk score (FRS) was evaluated by net reclassification index (NRI) and C-statistics, which showed significant improvement (NRI=22%, p<0.001) (C-statistics: FRS=0.49, FRS+Ln-RHI=0.62, p=0.005). CONCLUSIONS: Endothelial function was significantly impaired in CKDpatients and correlated with the presence of CAD. Severe endothelial dysfunction was an independent and incremental predictor of cardiovascular events in CKD.
Authors: Jordana B Cohen; Tiffany C Wong; Bruce S Alpert; Raymond R Townsend Journal: J Clin Hypertens (Greenwich) Date: 2017-01-12 Impact factor: 3.738
Authors: Andreas B Gevaert; Katrien Lemmens; Christiaan J Vrints; Emeline M Van Craenenbroeck Journal: Oxid Med Cell Longev Date: 2017-06-19 Impact factor: 6.543