@article {700, title = {Prevalence of renovascular disease in the elderly: a population-based study.}, journal = {J Vasc Surg}, volume = {36}, year = {2002}, month = {2002 Sep}, pages = {443-51}, abstract = {

PURPOSE: The purpose of this investigation was to estimate the population-based prevalence of renovascular disease (RVD), defined as > or = 60\% diameter-reducing renal artery stenosis or occlusion, and to define its associations with age, gender, race, and other potential risk factors among participants in the Cardiovascular Health Study (CHS).

METHODS: The CHS is a multicenter, longitudinal cohort study of cardiovascular disease risk factors, morbidity, and mortality among free-living adults of more than 65 years of age. As part of an ancillary investigation, participants in the Forsyth County cohort of the CHS were invited to undergo renal duplex sonography (RDS) to define the presence or absence of RVD. RVD was defined as stenosis with a focal renal artery peak systolic velocity exceeding 1.8 m/s in the main renal artery and defined as occlusion when an imaged renal artery lacked a Doppler signal. Demographic and atherosclerotic risk factor data were gathered as part of the baseline CHS examination. Univariable tests of association were performed with chi(2) and Student t tests and logistic regression analysis. Multivariate associations were examined with logistic regression analysis.

RESULTS: Eight hundred seventy CHS participants underwent RDS. Of these examinations, 834 (96\%) were technically adequate to define the presence or absence of RVD. The RDS study cohort had a mean age of 77.2 +/- 4.9 years and consisted of 63\% women and 37\% men. Participant race was 76\% white and 23\% African American. The overall prevalence rate of RVD was 6.8\%. Among the 57 patients with RVD, 50 (88\%) had unilateral disease and seven (12\%) had bilateral disease. Seven cases were seen of renal artery occlusion, including one case with contralateral renal artery stenosis. The mean ages of patients with and without RVD were 78.7 +/- 5.7 years and 77.1 +/- 4.9 years (P =.018). RVD was present in 5.5\% of women and 9.1\% of men (P =.053). RVD was present in 6.9\% of white participants and 6.7\% of African American participants (P =.933). Multivariate analysis revealed increasing participant age (P =.028; odds ratio, 1.34; 95\% CI, 1.03, 1.73), high-density lipoprotein cholesterol levels of less than 40 mg/dL (P =.003; odds ratio, 2.63; 95\% CI, 1.40, 4.93), and increasing systolic blood pressure (P =.007; odds ratio, 1.44; 95\% CI, 1.10, 1.87) to be significantly and independently associated with the presence of RVD.

CONCLUSION: This investigation provides the first population-based estimate of the prevalence of RVD among free-living, elderly black and white Americans. RVD was present in 6.8\% of the study cohort. RVD showed no association with ethnicity. However, its presence was significantly and independently associated with increasing age, low high-density lipoprotein cholesterol levels, and increasing systolic blood pressure.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cohort Studies, Ethnic Groups, Female, Humans, Longitudinal Studies, Male, Prevalence, Prospective Studies, Renal Artery, Renal Artery Obstruction, Risk Factors, Sex Factors, Ultrasonography, Doppler, Duplex}, issn = {0741-5214}, doi = {10.1067/mva.2002.127351}, author = {Hansen, Kimberley J and Edwards, Matthew S and Craven, Timothy E and Cherr, Gregory S and Jackson, Sharon A and Appel, Richard G and Burke, Gregory L and Dean, Richard H} } @article {737, title = {Relationships between renovascular disease, blood pressure, and renal function in the elderly: a population-based study.}, journal = {Am J Kidney Dis}, volume = {41}, year = {2003}, month = {2003 May}, pages = {990-6}, abstract = {

BACKGROUND: The purpose of this study is to examine the associations between renovascular disease (RVD) and cross-sectional measures of blood pressure and renal function among participants in the Cardiovascular Health Study (CHS).

METHODS: The CHS is a prospective cohort study of cardiovascular disease among elderly Americans. As part of an ancillary study, participants in the Forsyth County, NC, cohort of the CHS were invited to undergo renal duplex sonography (RDS) to define the presence or absence of RVD (defined as any focal peak systolic velocity > or = 1.8 milliseconds or the absence of a Doppler shifted signal from an imaged artery). Demographic, risk factor, blood pressure, and serum creatinine data were obtained at the time of RDS and from the annual CHS examination.

RESULTS: Eight hundred thirty-four CHS participants (including 525 women [63\%], 309 men [37\%], 194 African Americans [23\%], and 635 Caucasians [76\%]) with a mean age of 77.2 +/- 4.9 years underwent successful RDS. RVD was present in 57 participants (6.8\%). When examined according to the presence or absence of RVD, significant univariate differences were observed in the prevalence of clinical hypertension (72\% versus 50\%; P = 0.001), systolic blood pressure (145 versus 136 mm Hg; P = 0.001), and renal insufficiency (16\% versus 8\%; P = 0.041). Multivariate analyses showed significant and independent associations for the presence of RVD with increasing systolic blood pressure (P = 0.034), clinical hypertension (odds ratio, 2.68; 95\% confidence interval, 1.44 to 4.99; P = 0.002), increasing serum creatinine level, and renal insufficiency (odds ratio, 2.21; 95\% confidence interval, 1.02 to 4.79; P = 0.043). A significant interaction was observed between the presence of RVD and increasing systolic blood pressure in association with increasing serum creatinine levels (P = 0.041).

CONCLUSION: These results suggest important population-based associations between RVD and cross-sectional measures of blood pressure and renal function. Furthermore, the observed relationship between RVD and increasing serum creatinine level was influenced strongly by increasing blood pressure.

}, keywords = {Aged, Blood Pressure, Female, Humans, Hypertension, Kidney, Kidney Diseases, Male, Prospective Studies, Ultrasonography, Doppler, Duplex, Vascular Diseases}, issn = {1523-6838}, doi = {10.1016/s0272-6386(03)00196-3}, author = {Edwards, Matthew S and Hansen, Kimberley J and Craven, Timothy E and Cherr, Gregory S and Bleyer, Anthony J and Burke, Gregory L and Dean, Richard H} } @article {765, title = {Associations between renovascular disease and prevalent cardiovascular disease in the elderly: a population-based study.}, journal = {Vasc Endovascular Surg}, volume = {38}, year = {2004}, month = {2004 Jan-Feb}, pages = {25-35}, abstract = {

Atherosclerotic renovascular disease (RVD) is a suspected contributor to the morbidity and mortality of cardiovascular disease (CVD) through its potential effects on blood pressure and excretory renal function as well as through its associations with other forms of CVD. However, population-based data regarding the associations between the presence of RVD and prevalent CVD are lacking. The Cardiovascular Health Study (CHS) is a prospective, multicenter cohort study of CVD among elderly Americans. As part of an ancillary study, participants in the Forsyth County, North Carolina, cohort of the CHS were invited to undergo renal duplex sonography (RDS) to establish the presence or absence of RVD (defined as any focal peak systolic velocity >/= 1.8 m/second or the absence of a Doppler-shifted signal from an imaged artery). Demographic, risk factor, and prevalent CVD data were obtained from the CHS coordinating center and matched with ancillary study participants. Eight hundred thirty-four CHS participants (including 525 women [63\%], 309 men [37\%], 194 African-Americans [23\%], and 635 Caucasians [76\%]) with a mean age of 77.2 +/-4.9 years underwent RDS examination. RVD was present in 57 participants (6.8\%). Overall, clinical and/or subclinical manifestations of CVD were present in 603 participants (72.3\%) at the time of RDS. Participants with RVD demonstrated a significantly greater prevalence of angina (p = 0.002), previous myocardial infarction (p < 0.001), >/= 25\% diameter-reducing internal carotid artery stenosis (p = 0.010), increased carotid intimal medial thickness (p = 0.003), and major electrocardiographic abnormalities (p = 0.013). Following adjustment for demographics and cardiovascular risk factors, the presence of RVD demonstrated a significant and independent association with prevalent coronary artery disease but not with prevalent cerebrovascular or lower extremity vascular disease. These results suggest important population-based associations between RVD and both clinical and subclinical manifestations of CVD, especially coronary artery disease.

}, keywords = {Aged, Arteriosclerosis, Cardiovascular Diseases, Cohort Studies, Humans, Hypertension, Renovascular, Longitudinal Studies, Male, Multivariate Analysis, Prevalence, Prospective Studies, Renal Artery Obstruction, Ultrasonography, United States}, issn = {1538-5744}, doi = {10.1177/153857440403800103}, author = {Edwards, Matthew S and Hansen, Kimberley J and Craven, Timothy E and Bleyer, Anthony J and Burke, Gregory L and Levy, Pavel J and Dean, Richard H} } @article {796, title = {Mesenteric artery disease in the elderly.}, journal = {J Vasc Surg}, volume = {40}, year = {2004}, month = {2004 Jul}, pages = {45-52}, abstract = {

PURPOSE: The purpose of this study was to estimate the population-based prevalence of mesenteric artery stenosis (MAS) and occlusion among independent elderly Americans.

METHOD: As part of an ancillary investigation to the Cardiovascular Health Study (CHS), participants in the Forsyth County, NC cohort had visceral duplex sonography of the celiac arteries and superior mesenteric arteries (SMAs). Critical MAS was defined by celiac peak systolic velocity >or=2.0 m/s and/or SMA peak systolic velocity >or=2.7 m/s. Occlusion of either vessel was defined by lack of a Doppler-shifted signal within the imaged artery. Demographic data, blood pressures, and blood lipid levels were collected as part of the baseline CHS examination. Participants{\textquoteright} weights were measured at baseline and before the duplex exam. Univariate tests of association were performed with two-way contingency tables, Student t tests, and Fisher exact tests. Multivariate associations were examined with logistic regression analysis.

RESULTS: A total of 553 CHS participants had visceral duplex sonography technically adequate to define the presence or absence of MAS. The study group had a mean age of 77.2 +/- 4.9 years and comprised 63\% women and 37\% men. Participant race was 76\% white and 23\% African-American. Ninety-seven participants (17.5\%) had MAS. There was no significant difference in age, race, gender, body mass index, blood pressure, cholesterol, or low-density lipoproteins for participants with or without MAS. Forward stepwise variable selection found renal artery stenosis (P =.008; odds ratio [OR], 2.85; 95\% confidence interval [CI], 1.31, 6.21) and high-density lipoprotein >40 (P =.02; OR, 3.03; 95\% CI, 1.17, 7.81) significantly associated with MAS in a multivariate logistic regression model. Eighty-three of the 97 participants with MAS (15.0\% of the cohort) had isolated celiac stenosis. Seven participants (1.3\% of the cohort) had combined celiac and SMA stenosis. Five participants (0.9\% of the cohort) had isolated SMA stenosis. Two participants (0.4\% of the cohort) had celiac occlusion. Considering all participants with MAS, there was no association with weight change. However, SMA stenosis and celiac occlusion demonstrated an independent association with annualized weight loss (P =.028; OR, 1.54; 95\% CI, 1.05, 2.26) and with renal artery stenosis (P =.001; OR, 9.48; 95\% CI, 2.62, 34.47).

CONCLUSION: This investigation provides the first population-based estimate of the prevalence of MAS among independent elderly Americans. MAS existed in 17.5\% of the study cohort. The majority had isolated celiac disease. SMA stenosis and celiac artery occlusion demonstrated a significant and independent association with weight loss and concurrent renal artery disease.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Arteriosclerosis, Celiac Artery, Cohort Studies, Female, Humans, Male, Mesenteric Arteries, Mesenteric Artery, Superior, Mesenteric Vascular Occlusion, Prevalence, Ultrasonography, Doppler, Duplex, Weight Loss}, issn = {0741-5214}, doi = {10.1016/j.jvs.2004.03.022}, author = {Hansen, Kimberley J and Wilson, David B and Craven, Timothy E and Pearce, Jeffrey D and English, William P and Edwards, Matthew S and Ayerdi, Juan and Burke, Gregory L} } @article {854, title = {Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the Cardiovascular Health Study.}, journal = {Am J Kidney Dis}, volume = {46}, year = {2005}, month = {2005 Aug}, pages = {214-24}, abstract = {

BACKGROUND: Microvascular abnormalities in the kidney are common histopathologic findings in individuals with chronic kidney disease or renal failure. These abnormalities may represent one manifestation of ongoing systemic microvascular damage. We hypothesized that retinal microvascular abnormalities, when present, would be associated with progressive renal dysfunction in elderly individuals.

METHODS: The Cardiovascular Health Study (CHS) is a prospective, multicenter, cohort study initiated in 1989 designed to examine cardiovascular risk factors, morbidity, and mortality in elderly Americans. As part of an ancillary study, CHS participants underwent retinal photography in 1997 and 1998. Retinal microvascular abnormalities were assessed and graded by using standardized measures. Retinal microvascular abnormalities were defined as retinopathy (hard and soft exudates, hemorrhages, or microaneurysms) and/or retinal arteriolar abnormalities (arteriovenous nicking, focal arteriolar narrowing, or lowest quartile arteriole-venule ratio). Associations between these abnormalities and observed 4-year changes in serum creatinine levels and estimated glomerular filtration rates (eGFRs) from study years 5 to 9 (encompassing years 1994 to 2001) were examined by using regression modeling.

RESULTS: A total of 1,394 CHS participants had retinal and serum creatinine data. After adjustments for age, race, sex, weight, diabetes, hypertension, angiotensin-converting enzyme inhibitor use, and proteinuria, participants with retinopathy showed a significant increase in serum creatinine level and decline in eGFR compared with those without retinopathy during the 4-year study period (+0.24 mg/dL [+21 micromol/L] versus -0.21 mg/dL [-19 micromol/L] and -0.48 mL/min/1.73 m2 [-0.01 mL/s/1.73 m2] versus +1.74 mL/min/1.73 m2 [+0.03 mL/s/1.73 m2], respectively). Participants with retinopathy also were significantly more likely to have an observed significant deterioration in renal function, defined as a 0.3-mg/dL (27-micromol/L) increase in serum creatinine level or 20\% or greater decline in eGFR (odds ratio, 3.20; 95\% confidence interval, 1.58 to 6.50; and odds ratio, 2.84; 95\% confidence interval, 1.56 to 5.16, respectively). These associations remained in separate stratified analyses of patients with and without diabetes. The presence of retinal arteriolar abnormalities was not associated with deteriorating renal function.

CONCLUSION: Retinal microvascular abnormalities defined as retinopathy were significantly associated with renal function deterioration. The observed findings were independent of effects of any associated diabetes or hypertension. These findings suggest that systemic microvascular disease may be associated with progressive renal dysfunction in the elderly population.

}, keywords = {African Americans, Aged, Aged, 80 and over, Aging, Antihypertensive Agents, Capillaries, Cohort Studies, Comorbidity, Creatinine, Diabetes Mellitus, Disease Progression, European Continental Ancestry Group, Female, Glomerular Filtration Rate, Humans, Hypertension, Kidney, Male, Photography, Prospective Studies, Proteinuria, Retina, Retinal Diseases, Retinal Vessels}, issn = {1523-6838}, doi = {10.1053/j.ajkd.2005.05.005}, author = {Edwards, Matthew S and Wilson, David B and Craven, Timothy E and Stafford, Jeanette and Fried, Linda F and Wong, Tien Y and Klein, Ronald and Burke, Gregory L and Hansen, Kimberley J} } @article {836, title = {Renal duplex parameters, blood pressure, and renal function in elderly people.}, journal = {Am J Kidney Dis}, volume = {45}, year = {2005}, month = {2005 May}, pages = {842-50}, abstract = {

BACKGROUND: Changes in renal artery and renal parenchyma perfusion are believed to correlate with severity of hypertension and worsened renal function, but population-based studies of these associations are not available. This study examines relationships between parameters derived from renal duplex sonography (RDS), blood pressure (BP), and excretory renal function in a population-based cohort of elderly Americans.

METHODS: Through an ancillary study to the Cardiovascular Health Study, 758 participants (37\% men; mean age, 77 years) underwent RDS in which flow velocities and frequency shifts were determined from spectral analysis of Doppler-shifted signals obtained from the renal artery and parenchyma. Associations of these duplex parameters with BP and inverse serum creatinine were examined by using multivariate regression techniques.

RESULTS: Main renal artery peak systolic flow velocity (PSV) showed independent associations with BP, with an SD increase in PSV (0.53 m/s) associated with a 3.3-mm Hg increase in systolic BP (SBP) and a 2.4-mm Hg decrease in diastolic BP (DBP). An SD decrease in end-diastolic frequency shift (EDF; 131 kHz) was associated with a 6.0-mm Hg increase in SBP, a 4.2-mm Hg decrease in DBP, and a significant 3.7\% decrease in inverse serum creatinine.

CONCLUSION: Increases in renal artery PSV and decreases in parenchymal EDF are associated with increased SBP and decreased DBP. Moreover, decreased parenchymal EDF showed significant associations with impaired excretory renal function. These results suggest that renal duplex parameters are associated with renal parenchymal changes caused by hypertension and progressive renal dysfunction in elderly people.

}, keywords = {African Americans, Aged, Aging, Arteriosclerosis, Blood Pressure, Cardiovascular Diseases, Cohort Studies, Creatinine, Cross-Sectional Studies, Diastole, Disease Progression, European Continental Ancestry Group, Female, Humans, Hypertension, Renovascular, Kidney, Kidney Diseases, Kidney Function Tests, Male, Renal Artery, Renal Artery Obstruction, Renal Circulation, Risk Factors, Sampling Studies, Systole, Ultrasonography, Doppler, Duplex, United States}, issn = {1523-6838}, doi = {10.1053/j.ajkd.2005.01.028}, author = {Pearce, Jeffrey D and Edwards, Matthew S and Craven, Timothy E and English, William P and Mondi, Matthew M and Reavis, Scott W and Hansen, Kimberley J} } @article {819, title = {Renovascular disease and the risk of adverse coronary events in the elderly: a prospective, population-based study.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Jan 24}, pages = {207-13}, abstract = {

BACKGROUND: Renovascular disease is a cause of secondary hypertension and renal insufficiency and is suspected to contribute to morbidity and mortality of coronary heart disease. This investigation prospectively examined associations between renovascular disease and adverse coronary events among a population-based sample of elderly Americans.

METHODS: The Cardiovascular Health Study is a prospective, multicenter cohort study of cardiovascular disease risk factors, morbidity, and mortality among Americans older than 65 years. Renal duplex sonography was performed on 870 individuals between January 1995 and February 1997. Renovascular disease was defined as any focal peak systolic velocity of 1.8 m/s or greater (renal artery stenosis) or the absence of a Doppler-shifted signal from an imaged artery (renal artery occlusion). Adverse coronary events were defined as hospitalized angina, fatal or nonfatal myocardial infarction, and coronary revascularization.

RESULTS: During a mean follow-up of 14 months, 68 participants experienced incident or recurrent adverse coronary events. The presence of renovascular disease demonstrated a significant relationship with adverse coronary events (hazard ratio, 1.96; 95\% confidence interval, 1.00-3.83; P = .05) that remained after controlling for the effects of coexisting atherosclerotic risk factors and prevalent cardiovascular disease. The relationship between renovascular disease and adverse coronary events was not dependent on the effects of increased blood pressure.

CONCLUSIONS: The presence of renovascular disease was associated with an increase in the risk of adverse coronary events in this sample. The increment in risk was not dependent on the effects of associated atherosclerotic risk factors, other prevalent cardiovascular disease, or increased blood pressure.

}, keywords = {Age Distribution, Aged, Aged, 80 and over, Analysis of Variance, Cohort Studies, Comorbidity, Coronary Disease, Female, Geriatric Assessment, Heart Function Tests, Humans, Hypertension, Renovascular, Incidence, Kidney Function Tests, Male, Multivariate Analysis, Probability, Prognosis, Prospective Studies, Risk Assessment, Severity of Illness Index, Sex Distribution, Survival Rate, Ultrasonography, Doppler, United States}, issn = {0003-9926}, doi = {10.1001/archinte.165.2.207}, author = {Edwards, Matthew S and Craven, Timothy E and Burke, Gregory L and Dean, Richard H and Hansen, Kimberley J} } @article {924, title = {Clinical course of mesenteric artery stenosis in elderly americans.}, journal = {Arch Intern Med}, volume = {166}, year = {2006}, month = {2006 Oct 23}, pages = {2095-100}, abstract = {

BACKGROUND: To examine prospectively the relationship between stenosis or occlusion of the celiac and superior mesenteric arteries and symptoms of chronic intestinal ischemia in free-living elderly patients in the United States.

METHODS: As part of an ancillary study to the Cardiovascular Health Study, participants in the Forsyth County (North Carolina) cohort underwent visceral duplex ultrasonography of the celiac and superior mesenteric arteries. Critical mesenteric artery stenosis (MAS) or occlusion was defined by Doppler flow ultrasound-derived criteria. Clinical outcomes were assessed at annual follow-up examinations and review of death certificates. Multivariate associations between the presence of MAS and all-cause mortality and adverse cardiovascular events were analyzed. Participants with MAS were contacted to determine the presence of symptoms consistent with chronic intestinal ischemia.

RESULTS: Of 553 participants who underwent visceral duplex ultrasonography, 97 (17.5\%) had disease of the celiac or superior mesenteric artery. At a mean follow-up of 6(1/2) years, 20 participants with MAS (20.6\%) and 93 without MAS (20.4\%) had died (relative risk, 1.01; 95\% confidence interval, 0.66-1.55). No deaths were attributed to intestinal infarction. No association existed between the presence of MAS and prevalent cardiovascular disease, all-cause mortality, or adverse cardiovascular events. A questionnaire was completed by 71\% of the surviving participants with MAS. No participant reported symptoms or weight loss consistent with chronic intestinal ischemia.

CONCLUSIONS: Mesenteric artery stenosis was a common finding in free-living elderly patients. At long-term follow-up, the presence of asymptomatic MAS was not associated with death or adverse cardiovascular events. Participants with asymptomatic MAS by duplex ultrasonographic criteria did not experience intestinal infarction or develop chronic intestinal ischemia.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Female, Humans, Male, Mesenteric Arteries, Mesenteric Vascular Occlusion, Proportional Hazards Models, Prospective Studies, Radiography, Risk Factors, Surveys and Questionnaires, Ultrasonography}, issn = {0003-9926}, doi = {10.1001/archinte.166.19.2095}, author = {Wilson, David B and Mostafavi, Kian and Craven, Timothy E and Ayerdi, Juan and Edwards, Matthew S and Hansen, Kimberley J} } @article {919, title = {Progression of atherosclerotic renovascular disease: A prospective population-based study.}, journal = {J Vasc Surg}, volume = {44}, year = {2006}, month = {2006 Nov}, pages = {955-62; discussion 962-3}, abstract = {

OBJECTIVE: Previous reports from select hypertensive patients suggest that atherosclerotic renovascular disease (RVD) is rapidly progressive and associated with a decline in kidney size and kidney function. This prospective, population-based study estimates the incidence of new RVD and progression of established RVD among elderly, free-living participants in the Cardiovascular Health Study (CHS).

METHOD: The CHS is a multicenter, longitudinal cohort study of cardiovascular risk factors, morbidity, and mortality among men and women aged >65 years old. From 1995 through 1996, 834 participants underwent renal duplex sonography (RDS) to define the presence or absence of significant RVD. Between 2002 and 2005, a second RDS study was performed in 119 participants (mean study interval, 8.0 +/- 0.8 years). Significant RVD was defined as hemodynamically significant stenosis (renal artery peak systolic velocity [RA-PSV] exceeding 1.8 m/s) or renal artery occlusion. Prevalent RVD was significant RVD at the first RDS, and incident disease was defined as new significant RVD at the second RDS. Significant change of RVD was defined as a change in RA-PSV of greater than two times the standard deviation of expected change over time, regardless of hemodynamic significance or progression to renal artery occlusion.

RESULTS: The second RDS study cohort included 119 CHS participants with 235 kidneys (35\% men; mean age, 82.8 +/- 3.4). On follow-up, no prevalent RVD (n = 13 kidneys; 6.0\%) progressed to occlusion. Twenty-nine kidneys without RVD at the first RDS demonstrated significant change in PSV at the second RDS; including nine kidneys with new significant RVD (8 new stenoses; 1 new occlusion). Controlling for within-subject correlation, the overall estimated change in RVD among all 235 kidneys was 14.0\% (95\% confidence interval [CI], 9.2\% to 21.4\%), with progression to significant RVD in 4.0\% (95\% CI, 1.9\% to 8.2\%). Longitudinal increase in diastolic blood pressure and decrease in renal length were significantly associated with progression to new (ie, incident) significant RVD but not prevalent RVD.

CONCLUSIONS: This is the first prospective, population-based estimate of incident RVD and progression of prevalent RVD among free-living elderly Americans. In contrast to previous reports among select hypertensive patients, CHS participants with a low rate of clinical hypertension demonstrated a significant change of RVD in only 14.0\% of kidneys on follow-up of 8 years (annualized rate, 1.3\% per year). Progression to significant RVD was observed in only 4.0\% (annualized rate, 0.5\% per year), and no prevalent RVD progressed to occlusion.

}, keywords = {Aged, Aged, 80 and over, Atherosclerosis, Blood Flow Velocity, Blood Pressure, Disease Progression, Female, Follow-Up Studies, Humans, Incidence, Male, North Carolina, Population Surveillance, Prognosis, Prospective Studies, Renal Artery Obstruction, Severity of Illness Index, Time Factors, Ultrasonography, Doppler, Duplex}, issn = {0741-5214}, doi = {10.1016/j.jvs.2006.07.031}, author = {Pearce, Jeffrey D and Craven, Brandon L and Craven, Timothy E and Piercy, K Todd and Stafford, Jeanette M and Edwards, Matthew S and Hansen, Kimberley J} } @article {1017, title = {Abdominal aortic aneurysms, increasing infrarenal aortic diameter, and risk of total mortality and incident cardiovascular disease events: 10-year follow-up data from the Cardiovascular Health Study.}, journal = {Circulation}, volume = {117}, year = {2008}, month = {2008 Feb 26}, pages = {1010-7}, abstract = {

BACKGROUND: Long-term data describing small abdominal aortic aneurysms (AAAs) and increasing infrarenal aortic diameters and their relationship to future surgical repair, total mortality, and incident cardiovascular disease (CVD) events, particularly among women, are sparse.

METHODS AND RESULTS: In 1992 to 1993, 4734 Cardiovascular Health Study participants > or = 65 years old had an abdominal aortic ultrasound evaluation. Of those screened, 416 had an AAA (infrarenal aortic diameter > or = 3.0 cm or an infrarenal/suprarenal ratio > or = 1.2). By 2002, there were 56 surgical AAA repairs and 10 AAA-related deaths. A single ultrasound screening demonstrated that aneurysm dilation > or = 3 cm identified 68\% of all AAA repairs over the next 10 years and 6 of the 10 AAA-related deaths in 4\% of the total population and that a > or = 2.5-cm dilation identified 91\% of all AAA repairs and 9 of the 10 deaths in 10\% of the total population. With adjusted Cox proportional hazard models, AAAs were associated with a higher risk of total mortality (hazard ratio 1.44, 95\% confidence interval 1.25 to 1.66) and incident CVD events (hazard ratio 1.52, 95\% confidence interval 1.25 to 1.85). Compared with diameters < 2.0 cm, infrarenal aortic diameters 2.0 to < 3.0 cm were associated with increased risk of incident CVD events in women and total mortality in men.

CONCLUSIONS: This study suggests that a 1-time screening of the abdominal aorta can acceptably identify individuals with a clinically significant AAA. Infrarenal aortic diameters > 2.0 cm are associated with a significantly increased risk of future CVD events and total mortality.

}, keywords = {Aged, Aged, 80 and over, Aorta, Abdominal, Aortic Aneurysm, Abdominal, Cause of Death, Female, Follow-Up Studies, Humans, Incidence, Intermittent Claudication, Kidney, Male, Prospective Studies, Risk Factors, Sex Distribution, Ultrasonography}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.107.720219}, author = {Freiberg, Matthew S and Arnold, Alice M and Newman, Anne B and Edwards, Matthew S and Kraemer, Kevin L and Kuller, Lewis H} } @article {1163, title = {Associations between renal duplex parameters and adverse cardiovascular events in the elderly: a prospective cohort study.}, journal = {Am J Kidney Dis}, volume = {55}, year = {2010}, month = {2010 Feb}, pages = {281-90}, abstract = {

BACKGROUND: Atherosclerotic renovascular disease is associated with an increased risk of cardiovascular disease (CVD) events. This study examines associations between Doppler-derived parameters from the renal artery and renal parenchyma and all-cause mortality and fatal and nonfatal CVD events in a cohort of elderly Americans.

STUDY DESIGN: Cohort study.

SETTING: A subset of participants from the Cardiovascular Health Study (CHS). Through an ancillary study, 870 (70\% recruitment) Forsyth County, NC, CHS participants consented to undergo renal duplex sonography to define the prevalence of renovascular disease in the elderly, resulting in 726 (36\% men; mean age, 77 years) technically adequate complete studies included in this investigation.

PREDICTOR: Renal duplex sonography-derived Doppler signals from the main renal arteries and renal parenchyma. Spectral analysis from Doppler-shifted frequencies and angle of insonation were used to estimate renal artery peak systolic and end diastolic velocity (both in meters per second). Color Doppler was used to identify the corticomedullary junction. Using a 3-mm Doppler sample, the parenchymal peak systolic and end diastolic frequency shift (both in kilohertz) were obtained. Resistive index was calculated as (1 - [end diastolic frequency shift/peak systolic frequency shift]) using Doppler samples from the hilar arteries of the left or right kidney with the higher main renal artery peak systolic velocity.

OUTCOMES \& MEASUREMENTS: Proportional hazard regression analysis was used to determine associations between renal duplex sonography-derived Doppler signals and CVD events and all-cause mortality adjusted for accepted cardiovascular risk factors. Index CVD outcomes were defined as coronary events (angina, myocardial infarction, and coronary artery bypass grafting/percutaneous coronary intervention), cerebrovascular events (stroke or transient ischemic attack), and any CVD event (angina, congestive heart failure, myocardial infarction, stroke, transient ischemic attack, and coronary artery bypass grafting [CABG]/percutaneous transluminal coronary intervention [PTCI]).

RESULTS: During follow-up, 221 deaths (31\%), 229 CVD events (32\%), 122 coronary events (17\%), and 92 cerebrovascular events (13\%) were observed. Renal duplex sonography-derived Doppler signals from the renal parenchyma were associated independently with all-cause mortality and CVD outcomes. In particular, increased parenchymal end diastolic frequency shift was associated significantly with any CVD event (HR, 0.73; 95\% CI, 0.62-0.87; P < 0.001). Marginally significant associations were observed between increases in parenchymal end diastolic frequency shift and decreased risk of death (HR, 0.86; 95\% CI, 0.73-1.00; P = 0.06) and decreased risk of cerebrovascular events (HR, 0.78; 95\% CI, 0.61-1.01; P = 0.06). Parenchymal end diastolic frequency shift was not significantly predictive of coronary events (HR, 0.84; 95\% CI, 0.67-1.06; P = 0.1).

LIMITATIONS: CHS participants showed a "healthy cohort" effect that may underestimate the rate of CVD events in the general population.

CONCLUSION: Renal duplex sonographic Doppler signals from the renal parenchyma showed significant associations with subsequent CVD events after controlling for other significant risk factors. In particular, a standard deviation increase in parenchymal end diastolic frequency shift was associated with 27\% risk reduction in any CVD event.

}, keywords = {Aged, Cardiovascular Diseases, Cohort Studies, Female, Humans, Kidney Diseases, Male, Renal Artery, Risk Factors, Ultrasonography, Doppler, Duplex}, issn = {1523-6838}, doi = {10.1053/j.ajkd.2009.10.044}, author = {Pearce, Jeffrey D and Craven, Timothy E and Edwards, Matthew S and Corriere, Matthew A and Crutchley, Teresa A and Fleming, Shawn H and Hansen, Kimberley J} }