Article Figures & Data
Figures
- Figure 1.
Relative risk of a major coronary heart disease event (myocardial infarction incidence, fatal coronary heart disease, or coronary revascularization) for each quartile increase in systolic blood pressure, body mass index, fibrinogen, total and HDL-cholesterol and triglycerides, waist circumference, leukocyte count, serum albumin, and for current smoking, anemia, and diabetes, by level of kidney function (estimated GFR ≥90, 60 to 89, and 15 to 59 ml/min). Adjusted for age, sex, race and Atherosclerosis Risk in Communities (ARIC) Study field center. Error bars represent 95% confidence intervals.
Tables
- Table 1.
Characteristicsa of Atherosclerosis Risk in Communities (ARIC) Study participants by level of estimated GFR (≥90, 60 to 89, and 15 to 59 ml/min per 1.73 m2)b
Risk Factor Estimated GFR (ml/min per 1.73 m2) P Trend ≥90 (n = 7213) 60–89 (n = 9878) 15–59 (n = 807) Age (yr) 53.4 54.3 56.1 <0.001 Men (%) 41.9 44.1 33.0 <0.001 Black (%) 38.6 17.3 21.8 <0.001 Traditional risk factors current smoking (%) 27.8 21.1 16.3 <0.001 physically active (%) 23.8 25.8 25.7 0.001 hypertension (%) 31.1 35.2 57.2 <0.001 systolic BP (mmHg) 122.0 121.4 125.1 0.217 BMI (kg/m2) 27.4 27.7 28.6 <0.001 obesity (BMI ≥30 kg/m2) 24.7 26.7 33.0 <0.001 glucose (mg/dl) 108.9 108.8 123.0 <0.001 diabetes (%) 11.5 10.2 19.6 0.001 total cholesterol (mg/dl) 215.9 217.5 221.5 0.002 HDL cholesterol (mg/dl) 55.7 53.8 49.9 <0.001 log triglycerides, log (mg/dl) 4.71 4.73 4.86 <0.001 Nontraditional risk factors waist circumference 96.4 96.8 99.5 <0.001 log Lp(a), log (mg/L) 3.98 4.03 4.15 <0.001 apolipoprotein-A1 (mg/dl) 136.7 134.8 129.5 <0.001 apolipoprotein-B (mg/dl) 92.8 95.3 99.6 <0.001 anemia (%) 7.9 6.7 13.9 0.023 leukocyte count (109 cells/L) 6.17 5.98 6.34 0.004 serum albumin (mg/dl) 3.85 3.87 3.82 0.358 fibrinogen (mg/dl) 306.4 303.3 322.2 0.249 ↵a Prevalence and levels for all variables except age, gender, and race are standardized to the ARIC population with CKD (age, 56.1 yr; gender, 33.0% male; and 21.8% black race).
↵b Participants were permitted to be in two groups if they changed level of GFR at visit 2 (e.g., someone with an estimated GFR ≥90 ml/min per 1.73 m2 at baseline and between 60 and 89 at visit 2 is counted in both the ≥90 and 60 to 89 ml/min per 1.73 m2 categories of this table with updated covariates at visit 2). At the ARIC baseline visit, 7213, 7252, and 391 ARIC participants had an estimated GFR ≥90, 60 to 89, and 15 to 59 ml/min per 1.73 m2, respectively. Of those with an estimated GFR ≥90 at visit 1, 2626 participants had an estimated GFR between 60 and 89 at visit 2, and 416 participants with an estimated GFR ≥60 ml/min per 1.73 m2 at visit 1 had an estimated GFR <60 ml/min per 1.73 m2 at visit 2. ARIC, Atherosclerosis Risk in Communities; BMI, body mass index.
- Table 2.
Characteristicsa of ARIC Study participants with CKD who did and did not develop a major CHD eventb during 10.5 yr of follow-up
Risk Factor No CHD (n = 699) Incident CHD during Follow-upb (n = 108) P Value Age (yr) 55.8 58.0 <0.001 Men (%) 29.5 54.7 <0.001 Black (%) 9.8 22.5 <0.001 Traditional risk factors current smoking (%) 15.1 24.4 0.026 physically active (%) 26.4 21.2 0.278 hypertension (%) 28.4 29.8 0.023 systolic BP (mmHg) 31.8 41.2 0.075 BMI (kg/m2) 124.3 130.4 0.007 obesity (BMI ≥30 kg/m2) 55.3 70.1 0.013 glucose (mg/dl) 118.9 150.0 <0.001 diabetes (%) 17.2 36.3 <0.001 total cholesterol (mg/dl) 218.8 239.9 <0.001 HDL cholesterol (mg/dl) 50.2 47.7 0.154 log triglycerides, log (mg/dl) 4.84 5.05 <0.001 Nontraditional risk factors waist circumference 99.0 102.9 0.009 log Lp(a), log (mg/L) 4.12 4.31 0.125 apolipoprotein-A1 (mg/dl) 129.8 127.3 0.408 apolipoprotein-B (mg/dl) 98.2 108.8 0.003 anemia (%) 13.2 18.9 0.124 leukocyte count (109 cells/L) 6.27 6.84 <0.001 serum albumin (mg/dl) 3.84 3.75 0.005 fibrinogen (mg/dl) 317.9 350.8 <0.001 ↵a Prevalence and levels reflect the visit at which CKD was first noted (visit 1 for 391 participants and visit 2 for 416 participants) and are standardized for all variables except age, gender, and race to the ARIC population with CKD (age, 56.1; gender, 33.0% male; and 21.8% black race).
↵b CHD events include myocardial infarction incidence, fatal CHD, or coronary revascularization. CKD, chronic kidney disease; CHD, coronary heart disease.
- Table 3.
Adjusted relative risks of a major CHD event (myocardial infarction incidence, fatal coronary heart disease, or coronary revascularization) associated with selected CHD risk factors among ARIC study participants with CKD
Risk Factor Adjusted Relative Risk (95% CIa) Age, Race, Genderb Multivariate Modelc Age, 5 yr 1.42 (1.20–1.68) 1.33 (1.11–1.60) Male gender 2.68 (1.81–3.96) 3.96 (2.52–6.21) Black 2.06 (0.67–6.36) 1.79 (0.55–5.85) Traditional risk factors current smoking 1.65 (1.01–2.67) 1.91 (1.16–3.15) physical activity 0.79 (0.48–1.28) 0.79 (0.48–1.31) hypertension 2.02 (1.27–3.22) 1.79 (1.11–2.89) systolic BP, 20 mmHg 1.33 (1.13–1.57) 1.26 (1.05–1.51) BMI, 5 kg/m2 1.25 (1.05–1.49) 1.16 (0.97–1.39) obese 1.52 (1.02–2.28) 1.23 (0.82–1.86) glucose, 40 mg/dl 1.31 (1.20–1.43) 1.26 (1.15–1.39) diabetes 3.06 (2.01–4.67) 2.88 (1.85–4.47) total cholesterol, 43 mg/dl 1.50 (1.25–1.79) 1.46 (1.25–1.70) HDL cholesterol, 17 mg/dl 0.79 (0.62–1.01) 0.93 (0.73–1.19) log triglycerides, 0.5 log (mg/dl) 1.38 (1.15–1.65) 1.12 (0.94–1.33) Nontraditional risk factors waist circumference, 13 cm 1.38 (1.13–1.69) 1.24 (1.00–1.55) log Lp(a), 1.2 log (mg/L) 1.24 (0.98–1.58) 1.20 (0.94–1.53) apolipoprotein-A1, 31 mg/dl 0.88 (0.70–1.12) 0.99 (0.78–1.26) apolipoprotein-B, 29 mg/dl 1.33 (1.13–1.56) 1.28 (1.10–1.49) anemia 1.96 (1.14–3.36) 2.01 (1.19–3.42) leukocyte count, 1.9 × 109 cells/L 1.24 (1.06–1.46) 1.10 (0.91–1.34) serum albumin, 0.332 mg/dl 0.65 (0.54–0.79) 0.76 (0.63–0.92) fibrinogen, 69 mg/dl 1.38 (1.19–1.59) 1.23 (1.07–1.41) - Table 4.
Relative riska (95% CI) of a major CHD eventb among ARIC study participants associated with quartile of CHD risk factor by level of kidney function (estimated GFR ≥90, 60 to 89, and 15 to 59 ml/min per 1.73 m2)
Quartile P Value for Trend 1 2 3 4 Systolic BP (mmHg) <111 112–122 123–138 ≥139 GFR ≥90 1.00 1.26 (0.89–1.78) 1.93 (1.41–2.63) 2.21 (1.56–3.13) <0.001 60–89 1.00 1.07 (0.87–1.32) 1.73 (1.44–2.07) 2.39 (1.96–2.91) <0.001 15–59 1.00 1.52 (0.82–2.83) 1.08 (0.57–2.05) 2.37 (1.33–4.21) 0.011 BMI (kg/m2) <24.7 24.7–27.5 27.6–31.4 ≥31.4 GFR ≥90 1.00 1.32 (0.98–1.79) 1.67 (1.23–2.26) 1.38 (0.99–1.92) 0.008 60–89 1.00 1.17 (0.97–1.41) 1.36 (1.13–1.65) 1.62 (1.32–1.98) <0.001 15–59 1.00 1.14 (0.60–2.17) 1.33 (0.72–2.45) 1.78 (0.97–3.25) 0.052 Total Cholesterol (mg/dl) <190 191–217 218–244 ≥245 GFR ≥90 1.00 1.44 (1.04–1.99) 1.73 (1.24–2.42) 2.04 (1.50–2.79) <0.001 60–89 1.00 1.19 (0.97–1.45) 1.50 (1.22–1.84) 2.22 (1.84–2.67) <0.001 15–59 1.00 1.29 (0.68–2.45) 1.98 (1.08–3.61) 2.25 (1.27–3.99) 0.002 HDL cholesterol (mg/dl) <40 40–49 50–61 ≥62 GFR ≥90 1.00 0.77 (0.59–1.00) 0.44 (0.32–0.61) 0.23 (0.16–0.35) <0.001 60–89 1.00 0.58 (0.50–0.69) 0.53 (0.44–0.64) 0.27 (0.21–0.35) <0.001 15–59 1.00 0.72 (0.43–1.23) 0.73 (0.42–1.30) 0.62 (0.34–1.14) 0.127 Triglycerides (mg/dl) <87 87–124 125–181 ≥182 GFR ≥90 1.00 1.53 (1.12–2.08) 1.77 (1.29–2.44) 2.51 (1.85–3.42) <0.001 60–89 1.00 1.47 (1.20–1.80) 1.82 (1.49–2.22) 2.47 (2.02–3.03) <0.001 15–59 1.00 1.84 (0.92–3.67) 1.74 (0.91–3.29) 2.73 (1.46–5.10) 0.002 Waist circumference (cm) <90 91–99 100–108 ≥109 GFR ≥90 1.00 1.51 (1.09–2.07) 1.70 (1.23–2.35) 1.81 (1.29–2.54) <0.001 60–89 1.00 1.35 (1.09–1.66) 1.45 (1.18–1.79) 1.98 (1.59–2.46) <0.001 15–59 1.00 0.82 (0.40–1.65) 1.26 (0.67–2.35) 1.77 (0.97–3.23) 0.013 Leukocyte count (109 cells/L) <4.9 5.0–6.0 6.1–7.2 ≥7.3 GFR ≥90 1.00 1.55 (1.10–2.19) 1.66 (1.15–3.38) 2.67 (1.93–3.68) <0.001 60–89 1.00 1.16 (0.95–1.43) 1.66 (1.35–2.05) 2.42 (1.99–2.95) <0.001 15–59 1.00 1.84 (0.94–3.63) 2.09 (1.04–4.21) 3.31 (1.74–6.32) <0.001 Serum albumin (mg/dl) GFR ≥90 1.00 0.62 (0.45–0.84) 0.67 (0.50–0.89) 0.46 (0.33–0.65) <0.001 60–89 1.00 0.68 (0.55–0.85) 0.81 (0.67–1.00) 0.75 (0.61–0.93) 0.147 15–59 1.00 0.57 (0.33–0.99) 0.52 (0.29–0.92) 0.38 (0.20–0.70) 0.003 Fibrinogen (mg/dl) <270 271–310 311–358 ≥359 GFR ≥90 1.00 1.32 (0.95–1.83) 1.80 (1.31–2.48) 2.77 (2.02–3.80) <0.001 60–89 1.00 1.52 (1.27–1.82) 2.06 (1.71–2.48) 2.54 (2.08–3.09) <0.001 15–59 1.00 1.46 (0.67–3.20) 3.68 (1.80–7.52) 4.27 (2.09–8.71) <0.001
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