ArticlesRisk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study
Introduction
Guidelines for lipid-lowering treatment mainly base initiation of treatment and therapeutic goals for LDL cholesterol on projected risk of coronary heart disease events. The US National Cholesterol Education Program Adult Treatment Panel III (ATP III) recommends that LDL cholesterol be reduced to lower than 2·6 mmol/L in patients with coronary heart disease or an equivalent disorder.1 The term coronary heart disease risk equivalent refers to a characteristic that leads to a 10-year risk of coronary death or myocardial infarction that is equivalent to the risk associated with previous myocardial infarction (generally >20% risk).2
ATP III guidelines classify diabetes as a coronary heart disease risk equivalent, partly because data show that people with diabetes are at very high risk of cardiovascular events.3 An expert panel has suggested that chronic kidney disease should also be regarded as a coronary heart disease risk equivalent.4 People with chronic kidney disease have high rates of cardiovascular events, particularly when proteinuria is present.5, 6 However, whether chronic kidney disease constitutes a coronary heart disease risk equivalent (compared with accepted criteria such as diabetes)—especially when proteinuria is included in the definition of chronic kidney disease—is unknown.
We used data from a large population-based cohort to examine the risk of hospital admission for myocardial infarction in people with previous myocardial infarction, diabetes mellitus, or chronic kidney disease compared with people without these disorders. We aimed to assess the merits of chronic kidney disease (with and without proteinuria) as a coronary heart disease risk equivalent.
Section snippets
Data sources and cohort
We did this study using two datasets: the Alberta Kidney Disease Network (AKDN) database7 and the National Health and Nutrition Examination Survey (NHANES) 2003–068 (appendix). We used the AKDN database7—a selection of routine laboratory data from all patients in Alberta, Canada—to estimate risk of hospital admission for myocardial infarction, and a secondary outcome of all-cause death in individuals with previous myocardial infarction, diabetes, or chronic kidney disease. We identified adults
Results
Table 1 shows baseline characteristics of the 1 268 029 participants who met the inclusion criteria in each risk group. Participants with previous myocardial infarction or chronic kidney disease were substantially older than were those with diabetes (table 1). During median follow-up of 48 months (IQR 25–65), 11 340 (1%) participants were admitted to hospital with myocardial infarction, and 47 712 (4%) died.
The unadjusted rate of myocardial infarction during follow-up was higher in people with
Discussion
In this population-based cohort of nearly 1·3 million people, the unadjusted rate of hospital admission for myocardial infarction during follow-up was substantially lower for people with diabetes or chronic kidney disease than for those with a history of myocardial infarction. However, the rate of first myocardial infarction during follow-up was slightly higher in those with chronic kidney disease (but without diabetes) than in those with diabetes (without chronic kidney disease), especially
References (38)
- et al.
Can universal access to health care eliminate health inequities between children of poor and nonpoor families?: a case study of childhood asthma in Alberta
Chest
(2003) - et al.
A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario
Am Heart J
(2002) - et al.
Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment
Kidney Int
(1999) - et al.
Calibration of serum creatinine in the National Health and Nutrition Examination Surveys (NHANES) 1988–1994, 1999–2004
Am J Kidney Dis
(2007) - et al.
Ten-year survival after acute myocardial infarction: comparison of patients with and without diabetes. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial
Am Heart J
(1997) - et al.
The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial
Lancet
(2011) - et al.
The impact of reclassifying moderate CKD as a coronary heart disease risk equivalent on the number of US adults recommended lipid-lowering treatment
Am J Kidney Dis
(2007) - et al.
Cardiovascular risk among adults with chronic kidney disease, with or without prior myocardial infarction
J Am Coll Cardiol
(2006) - et al.
The case for chronic kidney disease, diabetes mellitus, and myocardial infarction being equivalent risk factors for cardiovascular mortality in patients older than 65 years
Am J Cardiol
(2008) - et al.
Chronic kidney disease as a predictor of cardiovascular disease (from the Framingham Heart Study)
Am J Cardiol
(2008)