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ARTICLE

The Prevalence of Nontraditional Risk Factors for Coronary Heart Disease in Patients with Chronic Kidney Disease

Paul Muntner, PhD; L. Lee Hamm, MD; John W. Kusek, PhD; Jing Chen, MD, MSc; Paul K. Whelton, MD, MSc; and Jiang He, MD, PhD

6 January 2004 | Volume 140 Issue 1 | Pages 9-17

Background: Risk for coronary heart disease is high among patients with chronic kidney disease.

Objective: To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR).

Design: Cross-sectional study.

Setting: Third National Health and Nutrition Examination survey.

Participants: 12 547, 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m², respectively, who were at least 18 years of age.

Measurements: Chronic kidney disease was defined as an estimated GFR of less than 60 mL/min per 1.73 m² based on the abbreviated Modification of Diet in Renal Disease formula.

Results: After standardization for age, race or ethnicity, and sex, lower estimated GFR ( 90, 60 to 89, or <60 mL/min per 1.73 m²) was associated with lower average levels of apolipoprotein A1 (1.44, 1.43, and 1.35 g/L) and higher levels of apolipoprotein B (1.03, 1.06, and 1.08 g/L), plasma fibrinogen (8.43, 8.44, and 9.53 µmol/L), homocysteine (8.5, 10.0, and 13.2 µmol/L), and C-reactive protein (3.0, 2.9, and 3.9 mg/L) (P < 0.05 for all values). The multivariate-adjusted odds ratios of an apolipoprotein A1 level of less than 1.2 g/L, a serum lipoprotein(a) level of at least 1.61 µmol/L ( 45.3 mg/dL), a plasma fibrinogen level of at least 10.35 µmol/L, a serum homocysteine level of at least 15 µmol/L, and a C-reactive protein level of at least 10.0 mg/L for participants with chronic kidney disease compared with those with a GFR of at least 90 mL/min per 1.73 m² or greater were 1.92 (95% CI, 1.02 to 3.63), 1.82 (CI, 1.06 to 3.13), 1.74 (CI, 1.35 to 2.24), 8.23 (CI, 5.00 to 13.6), and 1.93 (CI, 1.33 to 2.81), respectively.

Conclusions: Levels of apolipoprotein A1 are decreased and levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein are increased among patients with chronic kidney disease.

Editors' Notes Context Traditional cardiovascular risk factors only partially account for the high risk for cardiovascular disease among patients with chronic kidney disease. Contribution The Third National Health and Nutrition Examination Survey indicates that adults with chronic kidney disease have lower apolipoprotein A1 levels and higher homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein levels than adults without chronic kidney disease. Each of these differences increases the risk for cardiovascular disease. Cautions This observational study cannot tell us whether treatment to influence these cardiovascular risk factors would improve cardiovascular outcomes in patients with chronic kidney disease. –The Editors

 

Author and Article Information

From Tulane University, New Orleans, Louisiana, and the National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, Bethesda, Maryland.

Grant Support: In part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (U01 DK60963), and the COBRE Program of the National Center for Research Resources, National Institutes of Health (P20 RR17659-01). Dr. Muntner also received partial support for this work from a Scientist Development Award from the American Heart Association (0235134N).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jiang He, MD, PhD, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Avenue SL18; e-mail, jhe{at}tulane.edu.

Current Author Addresses: Drs. Muntner, Hamm, Chen, Whelton, and He: Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112.

Dr. Kusek: National Institutes of Health, 6707 Democracy Boulevard, Room 617, Bethesda, MD 20817.

Author Contributions: Conception and design: P. Muntner, L.L. Hamm, J. Chen, J. He.

Analysis and interpretation of the data: P. Muntner, J.W. Kusek, J. Chen, P.K. Whelton, J. He.

Drafting of the article: P. Muntner, J.W. Kusek, P.K. Whelton, J He.

Critical revision of the article for important intellectual content: L.L. Hamm, J.W. Kusek, J. Chen, P.K. Whelton, J. He.

Final approval of the article: P. Muntner, L.L. Hamm, J.W. Kusek, J. Chen, P.K. Whelton, J. He.

Statistical expertise: P. Muntner, J. He.

Administrative, technical, or logistic support: J. Chen, J. He.

Collection and assembly of data: P. Muntner.

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