Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study - PubMed (original) (raw)

Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study

Tobias Kurth et al. BMJ. 2009.

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Abstract

Objective: To evaluate the association of kidney function with cardiovascular disease and mortality among apparently healthy women.

Design: Prospective cohort study.

Setting: Women's Health Study, United States.

Participants: 27 939 female health professionals aged >or=45 who were free of cardiovascular disease and other major disease and who provided a blood sample at study entry.

Main outcome measures: Time to cardiovascular disease (non-fatal stroke, non-fatal myocardial infarction, coronary revascularisation procedures, or death from cardiovascular cause), specific cardiovascular disease events, and all-cause mortality. End points were confirmed after review of medical records and death certificates.

Results: Glomerular filtration rate (GFR) was estimated with the abbreviated Modification of Diet in Renal Disease Study equation. At baseline, 1315 (4.7%) women had GFR <60 ml/min/1.73 m(2). During 12 years of follow-up, 1199 incident cardiovascular disease events and 856 deaths (179 from cardiovascular disease) occurred. Compared with women with GFR >or=90 ml/min/1.73 m(2), the multivariable adjusted hazard ratios for any first cardiovascular disease were 0.95 (95% CI 0.83 to 1.08), 0.84 (0.70 to 1.00), and 1.00 (0.79 to 1.27) among women with GFR of 75-89.9, 60-74.9, and <60 ml/min/1.73 m(2), respectively; the equivalent hazard ratios for all cause mortality were 0.93 (0.79 to 1.09), 1.03 (0.85 to 1.26), and 1.09 (0.83 to 1.45). Similar null findings were observed for myocardial infarction, stroke, coronary revascularisation, and non-cardiovascular death. However, an increased risk of death from cardiovascular disease was found among women with GFR <60 ml/min/1.73 m(2) (hazard ratio 1.68 (1.02 to 2.79)).

Conclusions: In this large cohort of women, a glomerular filtration rate <60 ml/min/1.73 m(2) was associated with increased risk of cardiovascular disease death but not other cardiovascular disease events or non-cardiovascular disease mortality. We observed no increase in risk of any of the outcomes among women with less severe impairment of kidney function.

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Conflict of interest statement

Competing interests: None declared, but we report a full disclosure for the past five years. TK has received research funding from Merck, McNeil Consumer & Specialty Pharmaceuticals, the National Institutes of Health, and Wyeth Consumer Healthcare; is a consultant to i3 Drug Safety and World Health Information Science Consultants, LLC; and received honorariums from Genzyme, Merck, and Pfizer for lectures. PEdJ has received research funding from the Dutch Kidney Foundation. NRC has received research funding and support from the National Institutes of Health and from Roche Molecular Systems. JEB has received research funding and support from Dow Corning Corporation and the National Institutes of Health; research support from Bayer Heath Care and the Natural Source Vitamin E Association; honorariums from Bayer for lectures; and serves on an external scientific advisory committee for a study by Procter & Gamble. PMR has received research funding and support from the American Heart Association, AstraZeneca, Bayer, Bristol-Myers Squibb, Dade-Behring, Doris Duke Charitable Foundation, James and Polly Annenberg La Vea Charitable Trusts, Leducq Foundation, the National Institutes of Health, Novartis, Merck, Donald W Reynolds Foundation, Pharmacia, Roche, Sanofi/Aventis, and Variagenics; is listed as coinventor on patents held by Brigham and Women’s Hospital on the use of inflammatory biomarkers in cardiovascular disease; and has served as consultant to AstraZeneca, Dade-Behring, Interleukin Genetics, Isis Pharmaceuticals, Sanofi/Aventis, and Schering-Plough,

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