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Kidney dysfunction and sudden cardiac death among women with coronary heart disease

Rajat Deo1, Feng Lin, Eric Vittinghoff

  • 1Division of Cardiology, Johns Hopkins Hospital, Baltimore, Md., USA.

Hypertension (Dallas, Tex. : 1979)
|April 9, 2008
PubMed

Insights

Women with coronary heart disease and reduced kidney function face a higher risk of sudden cardiac death. Advanced kidney dysfunction is an independent predictor, even after accounting for heart failure and heart attack.

Area of Science:

  • Cardiology
  • Nephrology
  • Epidemiology

Background:

  • Coronary heart disease (CHD) is a leading cause of mortality in postmenopausal women.
  • Kidney dysfunction is an emerging risk factor for cardiovascular events.
  • The relationship between kidney function and sudden cardiac death (SCD) in women with CHD requires further investigation.

Purpose of the Study:

  • To evaluate the association between kidney dysfunction and the risk of sudden cardiac death (SCD) among ambulatory women with established coronary heart disease (CHD).

Main Methods:

  • Analysis of data from the Heart and Estrogen Replacement Study (HERS) involving 2763 postmenopausal women with CHD.
  • Kidney function assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation.
  • Multivariate proportional hazards models used to adjust for cardiovascular risk factors, congestive heart failure (CHF), and myocardial infarction (MI).

Main Results:

  • A significant trend of increasing SCD rates with declining kidney function was observed (P < 0.001).
  • Women with eGFR < 40 mL/min had a significantly higher risk of SCD (Hazard Ratio: 3.2; 95% CI: 1.9 to 5.3) compared to those with eGFR > 60 mL/min.
  • This association remained significant after adjusting for baseline risk factors and was partially mediated by incident CHF and MI during follow-up (HR: 2.3; 95% CI: 1.3 to 3.9).

Conclusions:

  • Advanced kidney dysfunction (eGFR < 40 mL/min) is an independent predictor of sudden cardiac death in women with coronary heart disease.
  • While heart failure and myocardial infarction partially mediate this risk, kidney dysfunction retains its independent predictive value.
  • These findings highlight the importance of assessing kidney function in women with CHD to identify those at elevated risk for SCD.

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