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Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD.
Am J Kidney Dis. 2007 Oct; 50(4):622-30.AJ

Abstract

BACKGROUND

Indices of arterial structure and stiffness are proposed as surrogate markers of cardiovascular disease in patients with chronic kidney disease (CKD), but no study examined multiple markers in the same population.

STUDY DESIGN

Prospective observational study.

SETTING & PARTICIPANTS

315 subjects with stages 4 to 5 CKD, aged 24 to 79 years (mean age, 56.6 +/- 13.6 [SD] years), enrolled in the Atherosclerosis and Folic Acid Supplementation Trial.

PREDICTORS

Carotid arterial intima-medial thickness (IMT; n = 315) and indices of arterial stiffness (n = 207), including aortofemoral pulse wave velocity (PWV[a-f]), systemic arterial compliance (SAC), and carotid-derived augmentation index.

OUTCOMES

The primary outcome was a composite of all fatal and nonfatal cardiovascular events.

RESULTS

During follow-up (median, 3.6 years), 95 cardiovascular events occurred. On Cox proportional-hazard modeling, mean maximum IMT, PWV(a-f), and SAC were predictive of the composite clinical end point of all cardiovascular events, but carotid-derived augmentation index was not (hazard ratio [HR] for every 0.01-mm increase in IMT, 1.09; P = 0.001; 95% confidence interval [CI], 1.03 to 1.14; HR for every 1-m/s increase in PWV(a-f), 1.18; P < 0.001; 95% CI, 1.12 to 1.25; HR for every 0.01-U/mm Hg decrease in SAC, 0.98; P = 0.01; 95% CI, 0.97 to 0.99). After adjustment for age, sex, blood pressure, diabetes, past cardiovascular disease, cholesterol level, and smoking, PWV(a-f) remained a significant independent predictor of cardiovascular events (adjusted HR, 1.12; P = 0.001; 95% CI, 1.05 to 1.20), but IMT and SAC did not.

LIMITATIONS

Study power to analyze differences between predialysis and dialysis stages of CKD.

CONCLUSIONS

PWV(a-f) is the only arterial index independently associated with cardiovascular outcome in patients with CKD.

Authors+Show Affiliations

Centre for Vascular Health, Monash University, Dandenong Hospital, Dandenong, Victoria, Australia. sophia.zoungas@med.monash.edu.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17900462

Citation

Zoungas, Sophia, et al. "Association of Carotid Intima-medial Thickness and Indices of Arterial Stiffness With Cardiovascular Disease Outcomes in CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 50, no. 4, 2007, pp. 622-30.
Zoungas S, Cameron JD, Kerr PG, et al. Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD. Am J Kidney Dis. 2007;50(4):622-30.
Zoungas, S., Cameron, J. D., Kerr, P. G., Wolfe, R., Muske, C., McNeil, J. J., & McGrath, B. P. (2007). Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 50(4), 622-30.
Zoungas S, et al. Association of Carotid Intima-medial Thickness and Indices of Arterial Stiffness With Cardiovascular Disease Outcomes in CKD. Am J Kidney Dis. 2007;50(4):622-30. PubMed PMID: 17900462.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of carotid intima-medial thickness and indices of arterial stiffness with cardiovascular disease outcomes in CKD. AU - Zoungas,Sophia, AU - Cameron,James D, AU - Kerr,Peter G, AU - Wolfe,Rory, AU - Muske,Christine, AU - McNeil,John J, AU - McGrath,Barry P, PY - 2007/02/14/received PY - 2007/07/17/accepted PY - 2007/9/29/pubmed PY - 2007/10/16/medline PY - 2007/9/29/entrez SP - 622 EP - 30 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 50 IS - 4 N2 - BACKGROUND: Indices of arterial structure and stiffness are proposed as surrogate markers of cardiovascular disease in patients with chronic kidney disease (CKD), but no study examined multiple markers in the same population. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: 315 subjects with stages 4 to 5 CKD, aged 24 to 79 years (mean age, 56.6 +/- 13.6 [SD] years), enrolled in the Atherosclerosis and Folic Acid Supplementation Trial. PREDICTORS: Carotid arterial intima-medial thickness (IMT; n = 315) and indices of arterial stiffness (n = 207), including aortofemoral pulse wave velocity (PWV[a-f]), systemic arterial compliance (SAC), and carotid-derived augmentation index. OUTCOMES: The primary outcome was a composite of all fatal and nonfatal cardiovascular events. RESULTS: During follow-up (median, 3.6 years), 95 cardiovascular events occurred. On Cox proportional-hazard modeling, mean maximum IMT, PWV(a-f), and SAC were predictive of the composite clinical end point of all cardiovascular events, but carotid-derived augmentation index was not (hazard ratio [HR] for every 0.01-mm increase in IMT, 1.09; P = 0.001; 95% confidence interval [CI], 1.03 to 1.14; HR for every 1-m/s increase in PWV(a-f), 1.18; P < 0.001; 95% CI, 1.12 to 1.25; HR for every 0.01-U/mm Hg decrease in SAC, 0.98; P = 0.01; 95% CI, 0.97 to 0.99). After adjustment for age, sex, blood pressure, diabetes, past cardiovascular disease, cholesterol level, and smoking, PWV(a-f) remained a significant independent predictor of cardiovascular events (adjusted HR, 1.12; P = 0.001; 95% CI, 1.05 to 1.20), but IMT and SAC did not. LIMITATIONS: Study power to analyze differences between predialysis and dialysis stages of CKD. CONCLUSIONS: PWV(a-f) is the only arterial index independently associated with cardiovascular outcome in patients with CKD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/17900462/Association_of_carotid_intima_medial_thickness_and_indices_of_arterial_stiffness_with_cardiovascular_disease_outcomes_in_CKD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(07)01041-4 DB - PRIME DP - Unbound Medicine ER -