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Published on: June 2, 2022
Progression of Coronary Artery Calcification and Risk of Clinical Events in CKD: The Chronic Renal Insufficiency
Ling Tian1, Byron C Jaeger2, Julia J Scialla3
1Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Translational Science Institute, Tulane University, New Orleans, Louisiana.
Insights
Coronary artery calcification progression in chronic kidney disease patients is linked to increased risks of cardiovascular disease and death. Early detection of CAC progression may aid in prognosis for kidney disease patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Radiology
Background:
- Coronary artery calcification (CAC) progression is accelerated in chronic kidney disease (CKD) patients.
- The association between CAC progression and adverse cardiovascular outcomes in CKD remains under investigation.
Purpose of the Study:
- To examine the association between CAC progression and risks of atherosclerotic cardiovascular disease (CVD), congestive heart failure, and all-cause mortality in adults with CKD.
- To determine if incident CAC or progressive CAC (≥50 Agatston units/year) impacts these risks.
Main Methods:
- Prospective cohort study of 1,310 participants from the Chronic Renal Insufficiency Cohort (CRIC) Study.
- CAC progression was categorized as incident CAC or progressive CAC (≥50 AU/year).
- Cause-specific Cox proportional hazards regression was used, stratified by baseline CAC presence.
Main Results:
- During a mean 3.3-year follow-up, 32.5% of participants without baseline CAC developed incident CAC, and 35.3% with baseline CAC showed progressive CAC.
- Incident CAC was associated with a 2.42-fold higher risk of atherosclerotic CVD and a 1.82-fold higher risk of all-cause mortality.
- Progressive CAC was associated with a 1.73-fold higher risk of all-cause mortality but not significantly with atherosclerotic CVD or heart failure.
Conclusions:
- CAC progression in adults with CKD stages 2-4 is associated with increased risks of atherosclerotic CVD and all-cause mortality.
- These associations were most pronounced in individuals without baseline CAC.
- Findings highlight the prognostic value of monitoring CAC changes in CKD patients.
Rationale & Objective:
Coronary artery calcification (CAC) progresses rapidly in people with chronic kidney disease (CKD) compared with the general population. We studied the association between CAC progression and higher risks of atherosclerotic cardiovascular disease (CVD), congestive heart failure, and all-cause mortality among adults with CKD.
Study Design:
Prospective cohort study.
Setting & Participants:
1,310 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who had at least 1 CAC scan with no prior history of CVD and with observed or imputed data on changes in CAC over time.
Exposure:
Observed or imputed CAC progression, categorized as incident CAC among participants with 0 CAC on the baseline scan or progressive CAC when the baseline scan demonstrated CAC and there was an increase in CAC≥50 Agatston units per year.
Outcome:
Atherosclerotic CVD (myocardial infarction or stroke), congestive heart failure, and all-cause mortality.
Analytical Approach:
Cause-specific Cox proportional hazards regression, stratified by presence of CAC at baseline.
Results:
A total of 545 participants without and 765 with prevalent CAC at baseline were included. During a mean 3.3 years between CAC assessments, 177 participants (32.5%) without baseline CAC developed incident CAC while 270 participants (35.3%) with baseline CAC developed a≥50 Agatston units per year increase in CAC. After multivariable adjustment, incident CAC was associated with 2.42-fold higher rate of atherosclerotic CVD (95% CI, 1.23-4.79) and 1.82-fold higher rate of all-cause mortality (95% CI, 1.03-3.22). Progressive CAC (≥50 units per year) was not associated with atherosclerotic CVD (HR, 1.42 [95% CI, 0.85-2.35]) but was associated with a 1.73-fold higher rate of all-cause mortality (95% CI, 1.31-2.28). Progressive CAC was not associated with incident heart failure.
Limitations:
Residual confounding and limited statistical power for some outcomes.
Conclusions:
Among adults with CKD stages 2-4, CAC progression over a mean 3.3 years was associated with higher risk of atherosclerotic CVD and all-cause mortality. The associations were strongest among participants without CAC at baseline.
Plain-Language Summary:
Prior research has shown that coronary artery calcification (CAC) is a marker of higher risk of heart disease and death. Less is known about how changes in CAC over time might affect risk, particularly among patients with kidney disease. In this study, participants with chronic kidney disease who developed CAC or had worsening CAC over time showed higher rates of heart attack, stroke, and death than those who did not develop CAC. These findings support the need for further research on longitudinal changes in CAC as a possible aid to establishing prognosis among patients with kidney disease and to inform treatment.
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