Is Chronic Kidney Disease a CHD Risk Equivalent?

June 19th, 2012

Is Chronic Kidney Disease a CHD Risk Equivalent?

Larry Husten, PHD

A study published in the Lancet provides new data about whether chronic kidney disease (CKD) should, like diabetes, be considered a coronary heart disease (CHD) risk equivalent.

Marcello Tonelli and colleagues analyzed data from a population of 1.25 million people in Alberta, Canada. During a median follow-up of 4 years, 11,340 people were admitted to the hospital for MI. People with a previous MI were at higher risk for MI admission than people with either diabetes or CKD:

MI history: 18.5 per 1000 person-years (CI 17.4–19.8)
Diabetes: 5.4 per 1000 person-years (5.2–5.7)
CKD: 6.9 per 1000 person-years (6.6–7.2)

After adjustment for other variables, the relative rate of MI was lower in the CKD group than in the diabetes group (rate and adjusted relative rate for MI admission):

Previous MI: 7.7%, RR 3.8 (CI 3.5-41)
Diabetes and CKD: 6%, RR 2.7 (2.5-2.9)
CKD: 2.8%, RR 1.4 (1.3-1.5)
Diabetes: 2.4%, RR 2.0 (1.9-2.1)
No diabetes or CKD: 0.5%, RR 1 (reference)

The authors write that their “data show that diabetes alone and chronic kidney disease alone … do not increase the rate of myocardial infarction to the same extent as does a history of coronary disease, and therefore do not support the use of the term coronary heart disease risk equivalent for either disorder.” However, they conclude that CKD should “be added to the list of criteria defining people at highest risk of future coronary events.”

In an accompanying comment, Tamar Polonsky and George Bakris write that “despite negative findings for the primary outcome, compelling reasons are provided to consider lipid-lowering therapy in patients with chronic kidney disease.”

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June 19th, 2012