Is chronic kidney disease associated with coronary artery stenosis or calcification as assessed by multi-detector row computed tomography?

Synergistic effect of renalase and chronic kidney disease on endothelin-1 in patients with coronary artery disease ‒ a cross-sectional study

Endothelin-1 (ET-1) is associated with endothelial dysfunction and vasoconstriction. Increased circulating ET-1 levels are associated with long-term cardiovascular mortality. Renalase, released from kidney, metabolizes catecholamines and regulates blood pressure. An increase in circulating renalase levels has been reported in patients with chronic kidney disease (CKD) and is associated with coronary artery disease (CAD). We hypothesized the existence of a synergistic effect of serum renalase levels and CKD on ET-1 levels in patients with CAD. We evaluated 342 non-diabetic patients with established CAD. ET-1 and renalase levels were measured in all patients after an overnight fast. Patients with CKD had higher ET-1 (1.95 ± 0.77 vs. 1.62 ± 0.76 pg/ml, P < 0.001) and renalase levels (46.8 ± 17.1 vs. 33.9 ± 9.9 ng/ml, P < 0.001) than patients without CKD. Patients with both CKD and high renalase levels (>the median of 36.2 ng/ml) exhibited the highest serum ET-1 (P value for the trend <0.001). According to multivariate linear regression analysis, the combination of high serum renalase levels with CKD was a significant risk factor for increased serum ET-1 levels (regression coefficient = 0.297, 95% confidence interval = 0.063‒0.531, P = 0.013). In conclusion, our data suggest a synergistic effect of high serum renalase levels and CKD on increases in ET-1 levels in patients with established CAD.

Increased detection of coronary atherosclerosis on 320-slice computed tomographic angiography with burden of cardiovascular risk factors and complications in patients with type 2 diabetes

AIMS

The cardiovascular risk factors and diabetic complications are related to coronary atherosclerosis. However, the evaluation of the prevalence of coronary atherosclerosis based on their accumulation remains to be determined.

METHODS

247 consecutive Chinese subjects with type 2 diabetes but without history of coronary heart disease (CHD) underwent 320-slice computed tomographic coronary angiography, including no coronary atherosclerosis, non-obstructive atherosclerosis (<50% stenosis) and obstructive atherosclerosis (≥50% stenosis). Conventional cardiovascular risk factors, albuminuria, renal dysfunction and diabetic retinopathy (DR) were determined. Framingham Risk Score (FRS) was used to assess the 10-year CHD risk.

RESULTS

Increase in burden of cardiovascular risk factors and diabetic complications were significantly associated with the likelihood of being a higher coronary atherosclerosis category. In the analysis for trend through the categories of burden score or FRS stratification, the percentage of obstructive atherosclerosis was increased and the percentage of no atherosclerosis decreased as the burden score and FRS increased (all p<0.005), respectively. The areas under the receiver operator curve for the burden score versus FRS were greater at predicting coronary atherosclerosis and obstructive atherosclerosis (p=0.004 and p=0.002), respectively.

CONCLUSIONS

The prevalence of coronary atherosclerosis was increased with the accumulation of cardiovascular risk factors and diabetic complications. The burden of these clinical and biochemical risk factors has increased ability for prediction of the presence and severity of coronary atherosclerosis over FRS in type 2 diabetic patients.

Correlation of coronary plaque characteristics and obstructive stenosis with chronic kidney disease by coronary CT angiography

BACKGROUND

Chronic kidney disease (CKD) is an independent risk factor for cardiovascular events. We evaluated the correlation of coronary plaque characteristics and obstructive stenosis with CKD by coronary computed tomographic angiography (CCTA).

METHODS

We enrolled 491 subjects who were suspected coronary artery disease (CAD) undergoing CCTA. Estimated glomerular filtration rate (eGFR) was calculated by the modification of diet in renal disease (MDRD) equation. Patients were subdivided into four groups based on their eGFR: normal GFR (n=213, eGFR ≥90 mL/min/1.73 m(2)), mild renal insufficiency (n=191, eGFR 60-89 mL/min/1.73 m(2)), moderate renal insufficiency(n=78, eGFR <60 mL/min/1.73 m(2), ≥30 mL/min/1.73 m(2)), and severe renal insufficiency (n=9, eGFR <30 mL/min/1.73 m(2), ≥15 mL/min/1.73 m(2)).

RESULTS

Spearman correlation regression analysis showed that the prevalence of any plaque, calcified plaque (CP), mixed plaque (MP) were positively correlate with CKD (r=0.173, P<0.001; r=0.127, P=0.005; r=0.171, P<0.001), after adjustment for traditional risk factors the prevalence of any plaque and MP were still positively correlate with CKD (r=0.106, P=002; r=0.178, P<0.001). And the prevalence of any stenosis and severe stenosis were positively correlate with CKD (r=0.13, P<0.001; r=0.149, P<0.001), after adjustment for traditional risk factors were still positively correlate with CKD (r=0.134, P=0.003; r=0.174, P<0.001).

CONCLUSIONS

CKD is closely related with occurrence of CAD. CKD patients from mild renal insufficiency to severe renal insufficiency are the risk factors for CAD. More serious renal function impairment will indicates higher risk of coronary plaque, MP and obstructive stenosis.

Hyperuricemia and the risk for subclinical coronary atherosclerosis--data from a prospective observational cohort study

Introduction

Our purpose was to test the hypothesis that hyperuricemia is associated with coronary artery calcification (CAC) among a relatively healthy population, and that the extent of calcification is directly proportional to the serum uric acid (sUA) concentration.

Methods

Data from 2,498 participants in the Coronary Artery Risk Development in Young Adults (CARDIA) study were analyzed using logistic regression models. Subjects were free of clinical heart disease, diabetes, and renal impairment. The main measure was the presence of any CAC by computerized tomography (Agatston score >0).

Results

Forty-eight percent of the study participants were male and 45% were African-American. Mean (± SD) age was 40 ± 4 years, body mass index 28 ± 6 kg/m², Framingham risk score -0.7 ± 5%, blood pressure 113 ± 14/75 ± 11 mmHg, alcohol consumption 12 ± 27 ml/day, and sUA 297 ± 89 μmol/L (5.0 ± 1.5 mg/dL). Prevalence of CAC increased with sUA concentration among both men and women. Adjusted for age, gender, race, lipoproteins, triglycerides, smoking, blood pressure, presence of metabolic syndrome, C-reactive protein, waist circumference, alcohol use, creatinine, and serum albumin, the highest quartile of sUA (>393 μmol/L [6.6 mg/dL] for men and >274 μmol/L [4.6 mg/dL] for women) was associated with an odds ratio of 1.87 (1.19-2.93) compared to the lowest quartile (<291 μmol/L [4.9 mg/dL] for men and <196 μmol/L [3.3 mg/dL] for women). Among those with any CAC, each unit increase in sUA was associated with a 22% increase in Agatston score (P = 0.008) after adjusting for the above covariates.

Conclusions

Hyperuricemia is an independent risk factor for subclinical atherosclerosis in young adults.

Association between hypertension and coronary artery disease as assessed by coronary computed tomography

Multidetector row computed tomography (MDCT) enables the accurate noninvasive assessment of coronary artery stenosis and plaque imaging. The characteristics of patients who have coronary artery disease (CAD) as assessed by MDCT coronary computed tomography (CT) are not well known. Participants consisted of 513 consecutive patients with suspected CAD who underwent coronary CT. The authors quantified patient characteristics, including the prevalence of hypertension (HTN), hyperlipidemia and diabetes mellitus (DM), visceral fat area (VFA) and subcutaneous fat area using CT, and plasma levels of metabolic factors, including adiponectin and leptin. Although plasma levels of adiponectin in men and leptin in women were significantly associated with chronic kidney disease, there were no differences in these levels between patients with and without CAD. HTN was most significantly associated with the presence of CAD by multivariate logistic regression analysis (men, P=.002; women, P=.048). Finally, the percentage of CAD significantly increased as systolic blood pressure increased (trend, P=.0002) in men but not women. In conclusion, hypertension was significantly associated with CAD as assessed by coronary CT.

Prognostic study of cardiac and renal events in Japanese patients with chronic kidney disease and cardiovascular risk using myocardial perfusion SPECT: J-ACCESS 3 study design

Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease. Recent studies have indicated that the incidence of cardiovascular disease increases inversely with estimated glomerular filtration rate. Although coronary angiography is considered the gold standard for detecting coronary artery disease, contrast-induced nephropathy or cholesterol microembolization remain serious problems; therefore, a method of detecting coronary artery disease without renal deterioration is desirable. From this viewpoint, stress myocardial perfusion single photon emission computed tomography (SPECT) might be useful for patients with chronic kidney disease. We recently performed the Japanese Assessment of Cardiac Events and Survival Study by Quantitative Gated SPECT (J-ACCESS) investigating patients with suspected or extant coronary artery disease and the J-ACCESS 2 study of patients with diabetes. The findings from these studies showed that SPECT can detect coronary artery disease and help to predict future cardiac events. Thus, we proposed a multicenter, prospective cohort study called "J-ACCESS 3" in patients with chronic kidney disease and cardiovascular risk. The study aimed at predicting cardiovascular and renal events based on myocardial perfusion imaging and clinical backgrounds. We began enrolling patients in J-ACCESS 3 at 74 facilities from April 2009 and will continue to do so until 31 March 2010, with the aim of having a cohort of 800 patients. These will be followed up for three years. The primary endpoints will be cardiac death and sudden death. The secondary endpoints will comprise any cardiovascular or renal events. This study will be completed in 2013. Here, we describe the design of the J-ACCESS 3 study.

Coronary artery calcification and cardiovascular risk: the role of RANKL/OPG signalling

BACKGROUND

Coronary artery disease (CAD) represents the most relevant cause of death and morbidity in the adult population of developed and developing countries. During the last decades, a strong research effort has been performed to identify more selective markers and better assess the cardiovascular risk in both primary and secondary prevention.

MATERIALS AND METHODS

This review updates current knowledge regarding the pathophysiological relevance as possible markers of coronary calcification of the receptor activator of nuclear factor-kappa ligand (RANKL)/osteoprotegerin (OPG) system. Furthermore, the potential clinical use of both RANKL/OPG and coronary calcium score (CAC) to assess cardiovascular vulnerability has been discussed.

RESULTS

Emerging evidence indicates that atherosclerotic plaque calcification is positively correlated with vulnerability. Several inflammatory mediators have been shown to modulate arterial calcification, thus increasing the risk of plaque rupture. Among these factors, RANKL/OPG axis might be of particular interest as a promising biomarker of plaque vulnerability in subjects with diffuse coronary calcification.

CONCLUSION

Together with clinical parameters of coronary calcification (such as CAC), circulating RANKL/OPG levels could contribute to better assess and predict cardiac events.