Maria García-Gil1, Dídac Parramon2, Marc Comas-Cufí2, Ruth Martí3, Anna Ponjoan3, Lia Alves-Cabratosa2, Jordi Blanch2, Irene Petersen4, Roberto Elosua5, María Grau5, Betlem Salvador6, Rafel Ramos7. 1. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain. 2. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain. 3. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain. 4. University College London, Department of Primary Care and Population Health, Rowland Hill Street, London NW3 2PF, UK. 5. Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain. 6. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; Cardiovascular, Epidemiology and Genetics Research Group, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; MACAP Renal Research Group, Research Unit in Primary Care, Primary Care Services, Costa Ponent. Catalan Institute of Health, Catalunya, Spain. 7. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute (IDIBGI), ICS, Catalunya, Spain. Electronic address: ramos.girona.ics@gencat.cat.
Abstract
BACKGROUND: Early-stage chronic kidney disease (CKD), a marker of cardiovascular risk, is susceptible to therapeutic intervention but need further study in populations with low incidence of coronary heart disease (CHD). Incorporating glomerular filtration rate (GFR) could improve cardiovascular risk prediction in these patients. OBJECTIVE: To determine if decreased GFR is associated with increased risk of cardiovascular morbidity and all-cause mortality and to analyse GFR effect on cardiovascular risk prediction in a population with low CHD incidence. METHODS: Retrospective, observational, population-based study of 1,081,865 adults (35-74years old). Main exposure variable: GFR. OUTCOMES: CHD, cerebrovascular disease, cardiovascular diseases, all-cause mortality. Association between GFR categories of CKD (G1-G5) and outcomes was tested with Cox survival models. G1 was defined as the reference category. Predictive value of GFR was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. RESULTS: Beginning at stage-3a CKD, increased risk was observed for coronary (HR 1.27 (95%CI 1.14-1.43)), cerebrovascular (HR 1.19 (95%CI 1.06-1.34)), cardiovascular (HR 1.23 (95%CI 1.13-1.34)) and all-cause mortality risk (HR 1.17 (95%CI 1.07-1.27)). GFR did not increase discrimination and reclassification indices significantly for any outcome. CONCLUSION: In general population with low CHD incidence and stage-3 CKD, impaired GFR was associated with increased risk of all cardiovascular diseases studied and all-cause mortality, but adding GFR values did not improve cardiovascular risk calculation. Despite a four-fold higher rate of CHD incidence at GFR G3a compared to G1, this represents moderate cardiovascular risk in our context.
BACKGROUND: Early-stage chronic kidney disease (CKD), a marker of cardiovascular risk, is susceptible to therapeutic intervention but need further study in populations with low incidence of coronary heart disease (CHD). Incorporating glomerular filtration rate (GFR) could improve cardiovascular risk prediction in these patients. OBJECTIVE: To determine if decreased GFR is associated with increased risk of cardiovascular morbidity and all-cause mortality and to analyse GFR effect on cardiovascular risk prediction in a population with low CHD incidence. METHODS: Retrospective, observational, population-based study of 1,081,865 adults (35-74years old). Main exposure variable: GFR. OUTCOMES: CHD, cerebrovascular disease, cardiovascular diseases, all-cause mortality. Association between GFR categories of CKD (G1-G5) and outcomes was tested with Cox survival models. G1 was defined as the reference category. Predictive value of GFR was evaluated by integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. RESULTS: Beginning at stage-3a CKD, increased risk was observed for coronary (HR 1.27 (95%CI 1.14-1.43)), cerebrovascular (HR 1.19 (95%CI 1.06-1.34)), cardiovascular (HR 1.23 (95%CI 1.13-1.34)) and all-cause mortality risk (HR 1.17 (95%CI 1.07-1.27)). GFR did not increase discrimination and reclassification indices significantly for any outcome. CONCLUSION: In general population with low CHD incidence and stage-3 CKD, impaired GFR was associated with increased risk of all cardiovascular diseases studied and all-cause mortality, but adding GFR values did not improve cardiovascular risk calculation. Despite a four-fold higher rate of CHD incidence at GFR G3a compared to G1, this represents moderate cardiovascular risk in our context.
Authors: Anna Ponjoan; Jordi Blanch; Lia Alves-Cabratosa; Ruth Martí-Lluch; Marc Comas-Cufí; Dídac Parramon; María Del Mar Garcia-Gil; Rafel Ramos; Irene Petersen Journal: Environ Health Date: 2017-04-04 Impact factor: 5.984
Authors: Vincenzo Livio Malavasi; Anna Chiara Valenti; Sara Ruggerini; Marcella Manicardi; Carlotta Orlandi; Daria Sgreccia; Marco Vitolo; Marco Proietti; Gregory Y H Lip; Giuseppe Boriani Journal: J Clin Med Date: 2022-02-08 Impact factor: 4.241