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Association of renal function with cardiac calcifications in older adults: the cardiovascular health study
Folkert W Asselbergs1, Dariush Mozaffarian, Ronit Katz
1Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. fwasselbergs@hotmail.com
Insights
Moderate kidney disease and elevated cystatin C levels are linked to mitral annulus calcification (MAC) in older adults. This study highlights the association between declining kidney function and cardiac calcifications, emphasizing the need for cardiovascular risk assessment in renal impairment.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are common in end-stage renal disease.
- The association between milder kidney disease and cardiac calcifications is less understood.
- This study investigates the link between renal function and MAC, aortic annular calcification (AAC), and AVS in the elderly.
Purpose of the Study:
- To evaluate the relationship between renal function and cardiac calcifications (MAC, AAC, AVS) in elderly individuals.
- To determine if reduced estimated glomerular filtration rate (eGFR) or elevated cystatin C levels are associated with these cardiac conditions.
Main Methods:
- Utilized data from the Cardiovascular Health Study, a community-based cohort of adults aged 65 and older.
- Assessed renal function using creatinine-based eGFR and cystatin C.
- Evaluated cardiac calcifications (MAC, AAC, AVS) via two-dimensional echocardiography in 3929 participants.
Main Results:
- Higher prevalence of MAC and AAC observed in individuals with eGFR < 45 mL/min/1.73 m².
- Elevated cystatin C levels were significantly associated with MAC and AAC.
- After adjustment, eGFR < 45 mL/min/1.73 m² was linked to MAC (OR 1.54), but not AAC or AVS.
- Cystatin C was independently associated with MAC (OR per SD 1.12), but not AAC or AVS.
Conclusions:
- Moderate kidney disease (eGFR < 45 mL/min/1.73 m²) and elevated cystatin C are associated with prevalent MAC in the elderly.
- A trend of increasing cardiac calcifications with declining renal function and higher cystatin C levels was observed.
- No significant associations were found between renal function and AAC or AVS.
Background:
Aortic valve sclerosis (AVS) and mitral annulus calcification (MAC) are highly prevalent in patients with end-stage renal disease. It is less well established whether milder kidney disease is associated with cardiac calcifications. We evaluated the relationships between renal function and MAC, aortic annular calcification (AAC) and AVS in the elderly.
Methods:
From the Cardiovascular Health Study, a community-based cohort of ambulatory adults >or= age 65, a total of 3929 individuals (mean +/- SD age 74 +/- 5 years, 60% women) were evaluated with two-dimensional echocardiography. Renal function was assessed by means of creatinine-based estimated glomerular filtration rate (eGFR) and cystatin C.
Results:
The prevalences of MAC and AAC were significantly higher in individuals with an eGFR < 45 mL/ min/1.73 m(2) (P < 0.01 for each), and cystatin C levels were significantly higher in individuals with MAC or AAC compared to individuals without these cardiac calcifications (P < 0.001 for each). After multivariate-adjustment, an eGFR <45 mL/min/1.73 m(2) was significantly associated with MAC [odds ratio 1.54 (95% CI 1.16-2.06), P = 0.003] and not associated with AAC [1.30 (0.97-1.74), P = 0.085] and AVS [1.15 (0.86-1.53), P = 0.355]. In addition, cystatin C levels were independently associated with MAC [odds ratio per SD 1.12 (1.05-1.21), P = 0.001] and not associated with AAC [1.07 (1.00-1.15), P = 0.054] and AVS [0.99 (0.93-1.06), P = 0.82]. Furthermore, the prevalence of multiple cardiac calcifications was higher in subjects with an eGFR < 45 mL/ min/1.73 m(2) and increased per quartile of cystatin C (P-values < 0.001). In addition, a significant trend was observed between an eGFR < 45 mL/min/1.73 m(2), increasing levels of cystatin C and the number of cardiac calcifications (P < 0.05).
Conclusions:
In a community-based cohort of the elderly, moderate kidney disease as defined by an eGFR <45 mL/min/1.73m(2) and elevated levels of cystatin C was associated with prevalent MAC. In addition, a significant trend was observed between an eGFR <45 mL/min/1.73m(2), increasing levels of cystatin C and the number of cardiac calcifications. No associations were found between renal function and AAC or AVS.
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