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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
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Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction
Nagesh S Anavekar1, John J V McMurray, Eric J Velazquez
1Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
The New England Journal of Medicine
|September 24, 2004
Summary
Even mild kidney disease significantly increases cardiovascular risks following a heart attack. This risk escalates as kidney function declines, impacting mortality and major cardiovascular events.
Area of Science:
- Cardiology
- Nephrology
- Clinical Research
Background:
- Coexisting conditions significantly impact acute myocardial infarction (AMI) outcomes.
- Renal failure presents a high risk, but milder renal impairment's influence is less defined.
Purpose of the Study:
- To assess the impact of varying degrees of renal impairment on cardiovascular outcomes in patients post-AMI.
- To evaluate the relationship between estimated glomerular filtration rate (GFR) and mortality/cardiovascular events.
Main Methods:
- Analysis of 14,527 patients from the Valsartan in Acute Myocardial Infarction Trial (VALIANT).
- Estimated GFR using the Modification of Diet in Renal Disease (MDRD) equation.
- Patients grouped by GFR; overall mortality and composite cardiovascular events compared across groups using a 70-variable model.
Main Results:
- Reduced GFR (<45.0 ml/min/1.73 m2) was associated with higher prevalence of risk factors and lower use of beneficial medications/procedures.
- Risk of death and composite cardiovascular events increased with declining GFR.
- Cardiovascular events predominated over renal events as GFR decreased.
Conclusions:
- Mild renal disease, indicated by estimated GFR, is a major risk factor for cardiovascular complications after myocardial infarction.
- Declining GFR independently predicts adverse cardiovascular outcomes, irrespective of treatment assignment.
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