1
|
Wang W, Reyes JL, Oyenuga A, Eaton AA, Norby FL, Parikh R, Inciardi RM, Alonso A, Lutsey PL, Herzog CA, Ishigami J, Matsushita K, Coresh J, Shah AM, Solomon SD, Chen LY. Association of Left Atrial Function With Incident Chronic Kidney Disease in Older Adults. Mayo Clin Proc Innov Qual Outcomes 2024; 8:343-355. [PMID: 38974529 PMCID: PMC11225621 DOI: 10.1016/j.mayocpiqo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Objective To examine the association of left atrial (LA) function with incident chronic kidney disease (CKD) and assess the clinical utility of adding LA function to a CKD risk prediction equation. Patients and Methods We included 4002 Atherosclerosis Risk in Communities study participants without prevalent CKD (mean ± SD age, 75±5 years; 58% female, 18% Black). Left atrial function (reservoir, conduit, and contractile strain) was evaluated by 2D-echocardiograms on 2011 to 2013. Chronic kidney disease was defined as greater than 25% decline in estimated glomerular filtration rate of less than 60 mL/min/1.73 m2, end-stage kidney disease, or hospital records. Cox proportional hazards models were used. Risk prediction and decision curve analyses evaluated 5-year CKD risk by diabetes status. Results Median follow-up was 7.2 years, and 598 participants developed incident CKD. Incidence rate for CKD was 2.29 per 100 person-years. After multivariable adjustments, the lowest quintile of LA reservoir, conduit, and contractile strain (vs highest quintile) had a higher risk of CKD (hazard ratios [95% CIs]: 1.94 [1.42-2.64], 1.62 [1.19-2.20], and 1.49 [1.12-1.99]). Adding LA reservoir strain to the CKD risk prediction equation variables increased the C-index by 0.026 (95% CI: 0.005-0.051) and 0.031 (95% CI: 0.006-0.058) in participants without and with diabetes, respectively. Decision curve analysis found the model with LA reservoir strain had a higher net benefit than the model with CKD risk prediction equation variables alone. Conclusion Lower LA function is independently associated with incident CKD. Adding LA function to the CKD risk prediction enhances prediction and yields a higher clinical net benefit. These findings suggest that impaired LA function may be a novel risk factor for CKD.
Collapse
Affiliation(s)
- Wendy Wang
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Jorge L. Reyes
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis
| | - Abayomi Oyenuga
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis
| | - Anne A. Eaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Faye L. Norby
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Romil Parikh
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Riccardo M. Inciardi
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Charles A. Herzog
- Department of Medicine and Chronic Disease Research Group, Hennepin Healthcare, University of Minnesota, Minneapolis
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amil M. Shah
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Scott D. Solomon
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA
| | - Lin Yee Chen
- Lillehei Heart Institute and Department of Medicine (Cardiovascular Division), University of Minnesota Medical School, Minneapolis
| |
Collapse
|
2
|
Maimaitiaili R, Zhao S, Teliewubai J, Yu S, Meng W, Zhao Y, Xu Y, Zhang Y. Vasculopathy Augments Cardiovascular Risk in Community-Dwelling Elderly with Left Ventricular Hypertrophy. J Pers Med 2024; 14:558. [PMID: 38929779 PMCID: PMC11204535 DOI: 10.3390/jpm14060558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to investigate the impact of various vasculopathies alongside left ventricular hypertrophy (LVH) on cardiovascular risk in the elderly. This prospective cohort study included 3339 older adults from the Northern Shanghai Study, classified into four mutually exclusive left ventricular (LV) geometry groups based on echocardiographic data: normal geometry, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. Vasculopathy was categorized into three primary types: arteriosclerosis, atherosclerosis, and renal senescence. Major adverse cardiovascular events (MACEs) were defined as non-fatal acute myocardial infarction, non-fatal stroke, and cardiovascular deaths according to ICD-10 codes. Over a median follow-up period of 5.7 years, 221 incident cases of MACEs were identified. Concentric hypertrophy exhibited the highest prevalence of hypertension, the most significant increase in vascular stiffness, and the highest rate of MACEs. The adjusted Cox regression analysis showed that eccentric hypertrophy is associated with an increased risk of MACEs (HR: 1.638 [95% CI: 1.151-2.331], p = 0.006), while concentric hypertrophy shows an even higher risk (HR: 1.751 [95% CI: 1.127-2.721], p = 0.013). Conversely, concentric remodeling was not significantly associated with an increased risk of MACEs. Renal senescence presents a moderate but significant risk for MACEs, with an HR of 1.361 (95% CI: 1.019-1.819; p = 0.037) when adjusted for LVH. The Kaplan-Meier analysis showed that patients with LVH and multiple vasculopathies experience the most significant decrease in survival probability (log-rank p < 0.001). The subgroup analysis revealed that LVH significantly raises the risk of MACEs, especially in older males with hypertension, diabetes, or vasculopathy. This study reinforces the importance of LVH as a predictor of adverse cardiovascular outcomes and underscores the compounded risk associated with the presence of multiple vasculopathies. Additionally, it highlights renal senescence as a distinct and independent risk factor for MACEs, separate from LVH.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 200072, China
| |
Collapse
|
3
|
Ikeda S, Shinohara K, Tagawa K, Tohyama T, Kishimoto J, Kazurayama M, Tanaka S, Yamaizumi M, Nagayoshi H, Toyama K, Matsushima S, Tsutsui H, Kinugawa S. Association of baseline electrocardiographic left ventricular hypertrophy with future renal function decline in the general population. Sci Rep 2024; 14:301. [PMID: 38167863 PMCID: PMC10761728 DOI: 10.1038/s41598-023-51085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/30/2023] [Indexed: 01/05/2024] Open
Abstract
Electrocardiographic left ventricular hypertrophy (LVH) could predict adverse renal outcomes in patients with hypertension. This study aimed to investigate the association between electrocardiographic LVH and future decline in renal function in the general population using a dataset of population-based health checkups from 2010 to 2019 including 19,825 participants. Electrocardiographic LVH was defined according to the Minnesota code. Renal function decline was defined as a decrease of ≥ 25% in the estimated glomerular filtration rate from baseline to < 60 mL/min/1.73 m2. Electrocardiographic LVH was found in 1263 participants at the baseline visit. The mean follow-up period was 3.4 ± 1.9 years. The incidence rates of renal function decline were 0.30 and 0.78 per 100 person-years in the non-LVH group and LVH groups, respectively. Electrocardiographic LVH was associated with the risk for renal function decline in the adjusted analysis (hazard ratio 1.69, 95% confidence interval 1.14-2.50, P = 0.009). This association was comparable across subgroups stratified by age, sex, body mass index, diagnosed hypertension, systolic blood pressure, hemoglobin A1c, and urinary protein. This study underscores the usefulness of electrocardiographic LVH to detect high-risk individuals for renal function decline in the setting of health checkups in the general population.
Collapse
Affiliation(s)
- Shota Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Koshiro Tagawa
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | | | | | | | | | - Kensuke Toyama
- JA Ehime Kouseiren Checkup Center, Ehime, Japan
- Department of Pharmacology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| |
Collapse
|
4
|
Tang L, Li S, Guo X, Lai J, Liu P, Fang J, Liu X. Combinative predictive effect of left ventricular mass index, ratio of HDL and CRP for progression of chronic kidney disease in non-dialysis patient. Int Urol Nephrol 2024; 56:205-215. [PMID: 37204678 DOI: 10.1007/s11255-023-03624-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE This current study scrutinized the association among left ventricular mass index (LVMI), ratio of high-density lipoprotein (HDL) and C-reactive protein (CRP), and renal function. Furthermore, we examined the predictive effects of left ventricular mass index and HDL/CRP on progression of non-dialysis chronic kidney disease. METHODS We enrolled adult patients with chronic kidney disease (CKD) who were not receiving dialysis and obtained follow-up data on them. We extracted and compared data between different groups. To investigate the relationship between left ventricular mass index (LVMI), high-density lipoprotein (HDL)/C-reactive protein (CRP) levels, and CKD, we employed linear regression analysis, Kaplan-Meier analysis, and Cox proportional hazards regression analysis. RESULTS Our study enrolled a total of 2351 patients. Compared with those in the non-progression group, subjects in the CKD progression group had lower ln(HDL/CRP) levels (- 1.56 ± 1.78 vs. - 1.14 ± 1.77, P < 0.001) but higher left ventricular mass index (LVMI) values (115.45 ± 29.8 vs. 102.8 ± 26.31 g/m2, P < 0.001). Moreover, after adjusting for demographic factors, ln(HDL/CRP) was found to be positively associated with estimated glomerular filtration rate (eGFR) (B = 1.18, P < 0.001), while LVMI was negatively associated with eGFR (B = - 0.15, P < 0.001). In the end, we found that both LVH (HR = 1.53, 95% CI 1.15 to 2.05, P = 0.004) and lower ln(HDL/CRP) (HR = 1.46, 95% CI 1.08 to 1.96, P = 0.013) independently predicted CKD progression. Notably, the combined predictive power of these variables was stronger than either variable alone (HR = 1.98, 95% CI 1.5 to 2.62, P < 0.001). CONCLUSION Our study findings indicate that in pre-dialysis patients, both HDL/CRP and LVMI are associated with basic renal function and are independently correlated with CKD progression. These variables may serve as predictors for CKD progression, and their combined predictive power is stronger than that of either variable alone.
Collapse
Affiliation(s)
- Leile Tang
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shaomin Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Xinghua Guo
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jiahui Lai
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Peijia Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Jia Fang
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Xun Liu
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China.
| |
Collapse
|
5
|
Ishigami J, Kansal M, Mehta R, Srivastava A, Rahman M, Dobre M, Al-Kindi SG, Go AS, Navaneethan SD, Chen J, He J, Bhat ZY, Jaar BG, Appel LJ, Matsushita K. Cardiac Structure and Function and Subsequent Kidney Disease Progression in Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2023; 82:225-236. [PMID: 36935072 PMCID: PMC10440229 DOI: 10.1053/j.ajkd.2023.01.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/05/2023] [Indexed: 03/19/2023]
Abstract
RATIONALE & OBJECTIVE Heart-kidney crosstalk is recognized as the cardiorenal syndrome. We examined the association of cardiac function and structure with the risk of kidney failure with replacement therapy (KFRT) in a chronic kidney disease (CKD) population. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 3,027 participants from the Chronic Renal Insufficiency Cohort Study. EXPOSURE Five preselected variables that assess different aspects of cardiac structure and function: left ventricular mass index (LVMI), LV volume, left atrial (LA) area, peak tricuspid regurgitation (TR) velocity, and left ventricular ejection fraction (EF) as assessed by echocardiography. OUTCOME Incident KFRT (primary outcome), and annual estimated glomerular filtration rate (eGFR) slope (secondary outcome). ANALYTICAL APPROACH Multivariable Cox models and mixed-effects models. RESULTS The mean age of the participants was 59±11 SD years, 54% were men, and mean eGFR was 43±17mL/min/1.73m2. Between 2003 and 2018 (median follow-up, 9.9 years), 883 participants developed KFRT. Higher LVMI, LV volume, LA area, peak TR velocity, and lower EF were each statistically significantly associated with an increased risk of KFRT, with corresponding HRs for the highest versus lowest quartiles (lowest vs highest for EF) of 1.70 (95% CI, 1.27-2.26), 1.50 (95% CI, 1.19-1.90), 1.43 (95% CI, 1.11-1.84), 1.45 (95% CI, 1.06-1.96), and 1.26 (95% CI, 1.03-1.56), respectively. For the secondary outcome, participants in the highest versus lowest quartiles (lowest vs highest for EF) had a statistically significantly faster eGFR decline, except for LA area (ΔeGFR slope per year, -0.57 [95% CI, -0.68 to-0.46] mL/min/1.73m2 for LVMI, -0.25 [95% CI, -0.35 to-0.15] mL/min/1.73m2 for LV volume, -0.01 [95% CI, -0.12 to-0.01] mL/min/1.73m2 for LA area, -0.42 [95% CI, -0.56 to-0.28] mL/min/1.73m2 for peak TR velocity, and -0.11 [95% CI, -0.20 to-0.01] mL/min/1.73m2 for EF, respectively). LIMITATIONS The possibility of residual confounding. CONCLUSIONS Multiple aspects of cardiac structure and function were statistically significantly associated with the risk of KFRT. These findings suggest that cardiac abnormalities and incidence of KFRT are potentially on the same causal pathway related to the interaction between hypertension, heart failure, and coronary artery diseases. PLAIN-LANGUAGE SUMMARY Heart disease and kidney disease are known to interact with each other. In this study, we examined whether cardiac abnormalities, as assessed by echocardiography, were linked to the subsequent progression of kidney disease among people living with chronic kidney disease (CKD). We found that people with abnormalities in heart structure and function had a greater risk of progression to advanced CKD that required kidney replacement therapy and had a faster rate of decline in kidney function. Our study indicates the potential role of abnormal heart structure and function in the progression of kidney disease among people living with CKD.
Collapse
Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
| | - Mayank Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Anand Srivastava
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mahboob Rahman
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio; Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology, Biostatistics and Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | | | - Jing Chen
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | | | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
6
|
Prevalence and Predictors of Renal Disease in a National Representative Sample of the Romanian Adult Population: Data from the SEPHAR IV Survey. Diagnostics (Basel) 2022; 12:diagnostics12123199. [PMID: 36553206 PMCID: PMC9777169 DOI: 10.3390/diagnostics12123199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background: The prevalence of chronic kidney disease (CKD) correlates with the prevalence of hypertension (HT). We studied the prevalence and predictors of CKD in a representative sample of the Romanian adult population. Methods: A sample of 1470 subjects were enrolled in the SEPHAR IV (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk) survey. All subjects were evaluated for blood pressure (BP) and extensive evaluations of target organ damage, blood, and urine samples were undertaken. Results: A total of 883 subjects were included in the statistical analysis. Those experiencing CKD with an eGFR < 60 mL/min/1.73 m2 were older at 71.94 ± 7.4 years (n = 19, 2.15%) compared with those without renal impairment at 50.3 ± 16.21 years (n = 864, 97.85%), p < 0.0001. The prevalence of CKD among hypertensives (379 from 883) was 4.49% (17/379), while 17 out of 19 subjects with CKD had HT (89.47%). After adjusting for age, sex, and diabetic status, only serum uric acid (SUR) > 6.9 mg/dL (OR: 6.61; 95% CI: 2.063, 10.83; p = 0.004) was an independent risk factor and a predictor of CKD. Conclusions: The prevalence of CKD in hypertensive Romanian adults was more than ten times higher than in the normotensive population. Levels of SUR > 6.9 mg/dL were predictors of CKD.
Collapse
|
7
|
Samson R, Ennezat PV, Le Jemtel TH, Oparil S. Cardiovascular Disease Risk Reduction and Body Mass Index. Curr Hypertens Rep 2022; 24:535-546. [PMID: 35788967 DOI: 10.1007/s11906-022-01213-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Anti-hypertensive and lipid lowering therapy addresses only half of the cardiovascular disease risk in patients with body mass index > 30 kg/m2, i.e., obesity. We examine newer aspects of obesity pathobiology that underlie the partial effectiveness of anti-hypertensive lipid lowering therapy for the reduction of cardiovascular disease risk in obesity. RECENT FINDINGS Obesity-related insulin resistance, vascular endothelium dysfunction, increased sympathetic nervous system/renin-angiotensin-aldosterone system activity, and glomerulopathy lead to type 2 diabetes, coronary atherosclerosis, and chronic disease kidney disease that besides hypertension and dyslipidemia increase cardiovascular disease risk. Obesity increases cardiovascular disease risk through multiple pathways. Optimal reduction of cardiovascular disease risk in patients with obesity is likely to require therapy targeted at both obesity and obesity-associated conditions.
Collapse
Affiliation(s)
- Rohan Samson
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA
| | | | - Thierry H Le Jemtel
- Section of Cardiology, John W. Deming Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70112, USA.
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
8
|
Kou M, Hishida M, Mathews L, Kitzman DW, Shah AM, Coresh J, Solomon S, Matsushita K, Ishigami J. Echocardiography-Based Cardiac Structure Parameters for the Long-term Risk of End-Stage Kidney Disease in Black Individuals: The Atherosclerosis Risk in Communities Study. Mayo Clin Proc 2022; 97:1794-1807. [PMID: 36202493 DOI: 10.1016/j.mayocp.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess whether echocardiographic parameters of left ventricular (LV) structure and function relate to the long-term risk of incident end-stage kidney disease (ESKD). PATIENTS AND METHODS We conducted a prospective cohort study analyzing 2137 Black participants from the Jackson site of the Atherosclerosis Risk in Communities Study from January 1, 1993, through July 31, 2017. Echocardiographic parameters of LV structure and function were obtained from 1993 to 1995. The primary outcome incident ESKD was identified through the linkage to the United States Renal Data System. Cox proportional hazards models were used to estimate the hazard ratios (HRs) according to each echocardiographic parameter. RESULTS There were 117 incident ESKD cases during a median follow-up of 22.2 (interquartile range, 15.0-23.3) years. Multivariable Cox models revealed that a higher LV mass index was significantly associated with the risk of ESKD (HR, 2.38; 95% CI, 1.21 to 4.68 for highest vs lowest quartile, P = 0.012). The HRs were significant and even higher for LV posterior wall thickness, with slightly higher HRs when their measures in end-systole (HR for highest vs lowest quartile, 4.38; 95% CI, 1.94 to 9.92, P < 0.001) vs end-diastole (HR, 3.50; 95% CI, 1.53 to 8.01, P = 0.003) were used. The associations were not significant for LV function parameters. CONCLUSION In Black individuals residing in the community, echocardiographic parameters of LV structure, including LV wall thickness, were robustly associated with the risk of subsequently incident ESKD. These results have potential implications for novel prevention and management strategies for persons with abnormal LV structure.
Collapse
Affiliation(s)
- Minghao Kou
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Manabu Hishida
- Department of Nephrology, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Lena Mathews
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Amil M Shah
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Scott Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| |
Collapse
|
9
|
Ishigami J, Mathews L, Hishida M, Kitzman DW, Coresh J, Solomon SD, Shah AM, Matsushita K. Echocardiographic measures and subsequent decline in kidney function in older adults: the Atherosclerosis Risk in Communities Study. Eur Heart J Cardiovasc Imaging 2022; 23:283-293. [PMID: 33517414 PMCID: PMC8787998 DOI: 10.1093/ehjci/jeaa418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/22/2020] [Indexed: 01/09/2023] Open
Abstract
AIMS Heart failure increases the risk of kidney disease progression. However, whether cardiac function and structure are associated with the risk of incident chronic kidney disease (CKD) is not well characterized in a community setting. METHODS AND RESULTS Among 4188 participants (mean age 75 years and 22% blacks) of the Atherosclerosis Risk in Communities Study without prevalent CKD in 2011-13, we examined the association of echocardiographic measures of left ventricular (LV) mass index, ejection fraction, left atrial volume index (LAVi), right ventricular (RV) fractional area change, and peak RV-right atrium (RA) gradient, with the subsequent risk of incident CKD, as defined by >25% decline to estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, hospitalization with CKD diagnosis, or incident end-stage kidney disease. Multivariable Cox regression models were used to estimate hazard ratios (HRs). The risk of incident CKD was monotonically increased with each of higher LV mass index [adjusted HR 2.61 (1.92-3.55) for highest quartile (Q4) vs. lowest (Q1)], lower ejection fraction [1.54 (1.17-2.04) for Q1 vs. Q4], higher LAVi [2.12 (1.56-2.89) for Q4 vs. Q1], and higher peak RV-RA gradient [2.17 (1.45-3.25) for Q4 vs. Q1] but not with RV function. The associations were consistent between subgroups by sex and race. CONCLUSION Among community-dwelling older individuals, LV mass index, ejection fraction, LAVi, and peak RV-RA gradient were independently associated with the risk of incident CKD. Our results further support that heart disease is associated with the risk of kidney disease progression and suggest the value of echocardiography for assessing cardiac and kidney health in older populations.
Collapse
Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21287, USA
| | - Lena Mathews
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21287, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Manabu Hishida
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21287, USA
| | - Dalane W Kitzman
- Division of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21287, USA
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21287, USA
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
10
|
Ferro CJ, Townend JN. Risk for subsequent hypertension and cardiovascular disease after living kidney donation: is it clinically relevant? Clin Kidney J 2021; 15:644-656. [PMID: 35371443 PMCID: PMC8967677 DOI: 10.1093/ckj/sfab271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
The first successful live donor kidney transplant was performed in 1954. Receiving a kidney transplant from a live kidney donor remains the best option for increasing both life expectancy and quality of life in patients with end-stage kidney disease. However, ever since 1954, there have been multiple questions raised on the ethics of live kidney donation in terms of negative impacts on donor life expectancy. Given the close relationship between reduced kidney function in patients with chronic kidney disease (CKD) and hypertension, cardiovascular disease and cardiovascular mortality, information on the impact of kidney donation on these is particularly relevant. In this article, we review the existing evidence, focusing on the more recent studies on the impact of kidney donation on all-cause mortality, cardiovascular mortality, cardiovascular disease and hypertension, as well as markers of cardiovascular damage including arterial stiffness and uraemic cardiomyopathy. We also discuss the similarities and differences between the pathological reduction in renal function that occurs in CKD, and the reduction in renal function that occurs because of a donor nephrectomy. Kidney donors perform an altruistic act that benefits individual patients as well as the wider society. They deserve to have high-quality evidence on which to make informed decisions.
Collapse
Affiliation(s)
- Charles J Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| |
Collapse
|
11
|
Chen Y, Sun G, Guo X, Li Z, Li G, Zhou Y, Yang H, Yu S, Zheng L, Sun Y. Performance of a novel ECG criterion for improving detection of left ventricular hypertrophy: a cross-sectional study in a general Chinese population. BMJ Open 2021; 11:e051172. [PMID: 34475185 PMCID: PMC8413944 DOI: 10.1136/bmjopen-2021-051172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The sensitivity of ECG for detecting left ventricular hypertrophy (LVH) is low. The aim of this study was to explore a better ECG criterion for screening LVH in a large general Chinese population. DESIGN Case-control study. SETTING China Medical University in Shenyang, China. PARTICIPANTS All permanent residents in Dawa, Zhangwu and Liaoyang aged 35 years or older were invited. Participants with unqualified data, pacemaker rhythm, frequent premature ventricular beats, Wolff-Parkinson-White syndrome, complete bundle branch block, myocardial infarction or hypertrophic cardiomyopathy were excluded. A total of 10 360 subjects (4630 males) were recruited. INTERVENTIONS A novel ECG criterion (Northeast China Rural Cardiovascular Health Study (NCRCHS)) composed of different ratios of maximum R wave in lead V5 or V6 (RV5/V6), S wave in lead V3 (SV3) and R wave in lead aVL (RaVL) was proposed and validated using multiple linear regression. Receiver-operating characteristic curves were used to compare the NCRCHS criterion with traditional criteria for LVH detection. RESULTS An optimised model (15*RaVL+8*SV3+7*RV5/V6) was constructed (R2 0.192, p<0.001) with the cut-off values of 36.8 mV for males and 26.1 mV for females. The maximum area under the curve was obtained using the NCRCHS criterion (male 0.74, 95% CI 0.73 to 0.75; female 0.73, 95% CI 0.72 to 0.75), followed by Cornell voltage criterion, Sokolow-Lyon criterion, Peguero-Lo Presti criterion, multi-ethnic study of atherosclerosis (MESA)-specific criterion and Syst-Eur voltage criterion. Compared with the Cornell voltage criterion, the NCRCHS criterion had a significantly higher sensitivity for detecting LVH at the same level of specificity (p<0.05). CONCLUSIONS The NCRCHS criterion significantly improved sensitivity for LVH detection in a general Chinese population, with cut-off values of 36.8 and 26.1 mV for males and females, respectively. This criterion can detect LVH earlier and better and may prevent subsequent cardiovascular diseases.
Collapse
Affiliation(s)
- Yanli Chen
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guozhe Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofan Guo
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhao Li
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guangxiao Li
- Department of Medical Record Management Center, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Zhou
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongmei Yang
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shasha Yu
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liqiang Zheng
- Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- Department of Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
12
|
Huang FY, Zhang JL, Huang BT, Peng Y, Chen SJ, Chen M. Renal function as a predictor of outcomes in patients with hypertrophic cardiomyopathy: A cohort study of a hospitalized population. Clin Chim Acta 2020; 512:92-99. [PMID: 33279500 DOI: 10.1016/j.cca.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/29/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The relationship between renal function and outcomes among patients with hypertrophic cardiomyopathy (HCM) remains undefined. We sought to investigate the prevalence of renal dysfunction and its prognostic value in HCM patients. METHODS A total of 581 patients with HCM were consecutively recruited. The chronic kidney disease epidemiology equation was used to estimate the glomerular filtration rate (eGFR). Patients were divided into 2 eGFR categories: ≥60 or <60 ml/min/1.73 m2. The predictive value of renal function was assessed using Cox regression. RESULTS The proportions of eGFR 60-90 ml/min/1.73 m2 and <60 ml/min/1.73 m2 were 41.8% and 15.3%, respectively. Estimated GFR independently predicted the risk of all-cause mortality [HR 0.98, 95% confidence interval (CI) 0.96-0.99, P < 0.001]. Compared to those with eGFR ≥ 60 ml/min/1.73 m2, patients with eGFR < 60 ml/min/1.73 m2 were independently associated with all-cause mortality (HR, 3.42 95% CI 1.86-6.28), cardiovascular mortality (HR 2.98, 95% CI 1.36-6.50) and combined adverse outcomes (HR 1.60, 95% CI 1.02-2.49). HRs for all-cause mortality with renal dysfunction were attenuated in patients with older ages (P for interaction = 0.034). CONCLUSIONS Renal dysfunction is a common comorbidity in HCM. Renal function is an independent predictor of outcomes in patients with HCM. These findings highlight the clinical importance of renal dysfunction in HCM.
Collapse
Affiliation(s)
- Fang-Yang Huang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China; State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Liang Zhang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bao-Tao Huang
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Peng
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shi-Jian Chen
- Cardiology Department, Minda Hospital of Hubei Minzu University, 2 Wufengshan Road, Enshi, Hubei, China.
| | - Mao Chen
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
13
|
Birukov A, Eichelmann F, Kuxhaus O, Polemiti E, Fritsche A, Wirth J, Boeing H, Weikert C, Schulze MB. Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications. Diabetes Care 2020; 43:2930-2937. [PMID: 32816995 PMCID: PMC7770272 DOI: 10.2337/dc20-0553] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Circulating N-terminal pro B-type natriuretic peptide (NT-proBNP) is a classic diagnostic and prognostic marker for heart failure. However, it is inversely associated with diabetes risk. We aimed to investigate relationships of NT-proBNP with risk of diabetes-related complications in initially healthy individuals. RESEARCH DESIGN AND METHODS We performed a case-cohort study within the European Prospective Investigation Into Cancer and Nutrition (EPIC)-Potsdam cohort including a random subcohort (n = 1,294) and incident cases of type 2 diabetes (n = 649) and cardiovascular diseases (n = 478). Incident cases of type 2 diabetes (n = 545) were followed up for microvascular (n = 133) and macrovascular (n = 50) complications. Plasma NT-proBNP was measured at baseline in initially healthy participants. RESULTS In multivariable models, NT-proBNP was linearly inversely associated with incident type 2 diabetes with a hazard ratio (HR) (95% CI) per doubling in NT-proBNP of 0.91 (0.86, 0.98). The association was only observable in women (0.80 [0.72, 0.90]) compared with men (0.98 [0.91, 1.07]). Among people with incident diabetes, NT-proBNP was positively associated with diabetes complications: overall, 1.31 (1.13, 1.53); microvascular complications, 1.20 (1.01, 1.43); and macrovascular complications, 1.37 (1.03, 1.83). CONCLUSIONS Although higher NT-proBNP levels are associated with lower diabetes risk, NT-proBNP is a biomarker for vascular complications in people who develop diabetes independent of potential confounders. Thus, NT-proBNP might be informative to monitor risk for diabetes-related microvascular and macrovascular complications, which should be further explored in future prospective studies.
Collapse
Affiliation(s)
- Anna Birukov
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Fabian Eichelmann
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Olga Kuxhaus
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Elli Polemiti
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,German Center for Diabetes Research, München-Neuherberg, Germany
| | - Andreas Fritsche
- Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, Department of Internal Medicine, University of Tübingen, Tübingen, Germany
| | - Janine Wirth
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - Cornelia Weikert
- Department of Food Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany .,German Center for Diabetes Research, München-Neuherberg, Germany.,Germany Institute of Nutrition Science, University of Potsdam, Nuthetal, Germany
| |
Collapse
|