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Hyperfibrinogenemia is an independent risk factor for atherosclerotic renal artery stenosis
1Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea. jspark@www.amc.seoul.kr
Insights
Older age, hypertension, and high fibrinogen levels are key risk factors for atherosclerotic renal artery stenosis. Identifying these factors is crucial for managing this progressive and correctable vascular disease.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Vascular Surgery
Background:
- Atherosclerotic renal artery stenosis (ARAS) is a progressive and potentially correctable condition.
- Early identification of patients at risk for ARAS is clinically significant.
Purpose of the Study:
- To determine the independent risk factors for atherosclerotic renal artery stenosis.
- To investigate the association between ARAS and various clinical, demographic, and laboratory parameters.
Main Methods:
- Renal arteriography was performed during cardiac catheterization in 270 patients with ischemic heart disease.
- Demographic, medical history, physical, and laboratory data were collected prior to the procedure.
- Coronary and renal artery stenosis were quantified using automatic edge detection; ARAS was defined as >50% diameter narrowing.
Main Results:
- Significant renal artery stenosis (RAS) was found in 10% of patients; 1% had bilateral disease.
- Univariate analysis associated older age, hypertension, extensive coronary artery disease, high fibrinogen, low albumin, and low hemoglobin with RAS.
- Multivariate analysis identified older age (OR: 2.43), hypertension (OR: 2.68), and higher fibrinogen levels (OR: 1.63) as independent risk factors for ARAS.
Conclusions:
- Older age, hypertension, and elevated fibrinogen levels are significant independent risk factors for atherosclerotic renal artery stenosis.
- Hyperfibrinogenemia, alongside advanced age and hypertension, contributes to the development of ARAS.
- These findings underscore the importance of considering these risk factors in the clinical evaluation of patients.
Abstract:
It is important to identify patients at risk for atherosclerotic renal artery stenosis because renal artery stenosis is a progressive disease and a potentially correctable problem. To determine the risk factors for atherosclerotic renal artery stenosis, we performed renal arteriography at the time of cardiac catheterization in 270 patients (M:F, 193:77, mean age: 59 years) with clinical ischemic heart disease. Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. The degree of coronary artery stenosis and renal artery stenosis was quantified with automatic edge detection technique. Significant renal artery stenosis, defined as a narrowing of the diameter by more than 50%, was identified in 28 (10%) patients. Three patients (1%) had bilateral disease. Significant coronary artery disease, defined as a narrowing of the diameter by more than 50%, was present in 231 patients (85%). By univariate logistic regression analysis, older age (68 +/- 8 vs. 58 +/- 10 years), the presence of hypertension (61% vs. 38%), the extent of coronary artery disease, a high fibrinogen level (391 +/- 93 mg/dl vs. 335 +/- 109 mg/dl), a low albumin level (3.9 +/- 0.4 g/dl vs. 4.1 +/- 0.4 g/dl), and a low hemoglobin level (12.5 +/- 1.6 g/dl vs. 13.5 +/- 1.6 g/dl) were associated with the presence of renal artery stenosis (p < 0.05). Serum lipids, lipoprotein(a), creatinine, sex, smoking, or diabetes were not associated. By multivariate logistic regression analysis, older age (OR: 2.43 analyzed by 10 years increment, p = 0.0001), the presence of hypertension (OR: 2.68, p = 0.039) and a higher fibrinogen level (OR: 1.63 analyzed by 100 mg/dl increment, p = 0. 038) were significant risk factors of renal artery stenosis. Fibrinogen level was negatively correlated with albumin level (r = -0.18, p = 0.004). These results suggest that hyperfibrinogenemia as well as old age and hypertension are independent risk factors for atherosclerotic renal artery stenosis.