The association of coronary artery calcium score with glomerular filtration rate and the influence of sex, age, blood pressure, and cholesterol
DOI:
https://doi.org/10.26641/2307-0404.2020.3.214809Keywords:
coronary artery calcium score, glomerular filtration rate, sex, age, blood pressure, cholesterolAbstract
Chronic kidney disease puts an individual at a higher risk of all-cause and cardiovascular death. Coronary artery calcium score reflects the accumulation of calcium in the walls of the coronary arteries and a higher coronary artery calcium score is associated with lower survival rates. It is unclear if control of conventional risk factors is enough to reduce cardiovascular risk in patients with chronic kidney disease. The aim of this study was to investigate if the association between estimated glomerular filtration rate and coronary artery calcium score in the Ukrainian population differs by sex, age, blood pressure, and total cholesterol.This cross-sectional study was conducted on a sample of patients who underwent measurement of coronary artery calcium score at Dnipropetrovsk Mechnikov Regional Hospital, Dnipro, Ukraine. Inclusion criteria: age >40 years old, available data about coronary artery calcium score and estimated glomerular filtration rate. Exclusion criteria: the presence of known cardiovascular disease, diagnosis of diabetes mellitus, estimated glomerular filtration rate <30 ml/min and extreme coronary artery calcification (coronary artery calcium score >1500 Agatston units). 137 patients (54 males and 83 females), median age 59.0 [54.0;67.0] years were enrolled in the study. In the patients with lower eGFR there was non-significantly higher coronary artery calcium score (p=0.07). In males with eGFR ≥90 ml/min, 60-89 ml/min, and 30-59 ml/min coronary artery calcium score didn’t differ significantly, while in females a lower estimated glomerular filtration rate was associated with a higher coronary artery calcium score. A lower estimated glomerular filtration rate was significantly associated with a higher coronary artery calcium score in the patients with systolic blood pressure ≥140 mmHg (p=0.04), but not in patients with diastolic blood pressure ≥90 mmHg. In the patients with total cholesterol <5.0 mmol/l and ≥5.0 mmol/l coronary artery calcium score tended to be higher in the patients with lower estimated glomerular filtration rate. A lower estimated glomerular filtration rate in our study was associated with a higher coronary artery calcium score in females, patients aged ≥55 years old and in patients with systolic blood pressure ≥140 mmHg.References
Valdivielso JM, Rodríguez-Puyol D, Pascual J, Barrios C, Bermúdez-López M, Sánchez-Niño MD, et al. Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different? Arterioscler Thromb Vasc Biol. 2019;39:1938-66. doi: https://doi.org/10.1161/ATVBAHA.119.312705
Delanaye P, Jager KJ, Bökenkamp A, Christensson A, Dubourg L, Eriksen BO, et al. CKD: A Call for an Age-Adapted Definition. J Am Soc Nephrol 2019;30:1785-805. doi: https://doi.org/10.1681/ASN.2019030238
Chen J, Budoff MJ, Reilly MP, Yang W, Rosas SE, Rahman M, et al. Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease. JAMA Cardiol 2017;2:635. doi: https://doi.org/10.1001/jamacardio.2017.0363
Wouters OJ, O’Donoghue DJ, Ritchie J, Kanavos PG, Narva AS. Early chronic kidney disease: diagnosis, management and models of care. Nat Rev Nephrol 2015;11:491-502. doi: https://doi.org/10.1038/nrneph.2015.85
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts) * Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2012;33:1635-701. doi: https://doi.org/10.1093/eurheartj/ehs092
Firke S. janitor: Simple Tools for Examining and Cleaning Dirty Data. R package version 1.2.1. https://CRAN.R-project.org/package=janitor
Hyun YY, Kim H, Oh K, Ahn C, Park SK, Chae DW, et al. eGFR and coronary artery calcification in chronic kidney disease. Eur J Clin Invest 2019;49:e13101. doi: https://doi.org/10.1111/eci.13101
Judd E, Calhoun DA. Management of Hypertension in CKD: Beyond the Guidelines. Adv Chronic Kidney Dis. 2015;22:116-22. doi: https://doi.org/10.1053/j.ackd.2014.12.001
Ecnoyan G, Lameire N, Echardt K, Kasiske B, Wheeler D, Abboud O. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3:1-150.
Mikolasevic I, Žutelija M, Mavrinac V, Orlic L. Dyslipidemia in patients with chronic kidney disease: etiology and management. Int J Nephrol Renov Dis 2017;10:35-45. doi: https://doi.org/10.2147/IJNRD.S101808
de Lemos JA, Ayers CR, Levine BD, de Filipp CR, Wang TJ, Hundley WG, et al. Multimodality Strategy for Cardiovascular Risk Assessment: Performance in 2 Population-Based Cohorts. Circulation. 2017;135:2119-32. doi: http://doi.org/10.1161/CIRCULATIONAHA.117.027272
Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe: epidemiological update. Eur Heart J 2013;34:3028-34. doi: https://doi.org/10.1093/eurheartj/eht356
Petrie A, Sabin C. Medical Statistics at a Glance. 4th edition. Wiley-Blackwell; 2019. p. 208.
Okwuosa TM, Greenland P, Burke GL, Eng J, Cushman M, et al. Prediction of Coronary Artery Calcium Progression in Individuals With Low Framingham Risk Score. JACC Cardiovasc Imaging. 2012;5:144-53. doi: https://doi.org/10.1016/j.jcmg.2011.11.008
R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Austria. Available from: https://www.R-project.org/
Kramer A, Pippias M, Noordzij M, Stel VS, Andrusev AM, Aparicio-Madre MI, et al. The European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry Annual Report 2016: a summary. Clin Kidney J 2019;12:702-20. doi: https://doi.org/10.1093/ckj/sfz011
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71:e127-248. doi:
Mancia G, Rosei EA, Azizi M, Burnier M, Clement DL, Coca A, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. J Hypertens. 2018;36:1953-2041. doi: https://doi.org/10.1097/HJH.0000000000001940
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111-88. doi: https://doi.org/10.1093/eurheartj/ehz455
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