03093nas a2200385 4500008004100000022001400041245010400055210006900159260001600228300001200244490000700256520198500263653000902248653002802257653002502285653001502310653001102325653001802336653001102354653003002365653002802395653000902423653001502432653003002447653002202477100002002499700002402519700001702543700002302560700002402583700002402607700002102631700002002652856003502672 2003 eng d a0735-109700aRenal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals.0 aRenal insufficiency as a predictor of cardiovascular outcomes an c2003 Apr 16 a1364-720 v413 a

OBJECTIVES: This study was designed to evaluate the relationship between elevated creatinine levels and cardiovascular events.

BACKGROUND: End-stage renal disease is associated with high cardiovascular morbidity and mortality. The association of mild to moderate renal insufficiency with cardiovascular outcomes remains unclear.

METHODS: We analyzed data from the Cardiovascular Health Study, a prospective population-based study of subjects, aged >65 years, who had a serum creatinine measured at baseline (n = 5,808) and were followed for a median of 7.3 years. Proportional hazards models were used to examine the association of creatinine to all-cause mortality and incident cardiovascular mortality and morbidity. Renal insufficiency was defined as a creatinine level > or =1.5 mg/dl in men or > or =1.3 mg/dl in women.

RESULTS: An elevated creatinine level was present in 648 (11.2%) participants. Subjects with elevated creatinine had higher overall (76.7 vs. 29.5/1,000 years, p < 0.001) and cardiovascular (35.8 vs. 13.0/1,000 years, p < 0.001) mortality than those with normal creatinine levels. They were more likely to develop cardiovascular disease (54.0 vs. 31.8/1,000 years, p < 0.001), stroke (21.1 vs. 11.9/1,000 years, p < 0.001), congestive heart failure (38.7 vs. 17/1,000 years, p < 0.001), and symptomatic peripheral vascular disease (10.6 vs. 3.5/1,000 years, p < 0.001). After adjusting for cardiovascular risk factors and subclinical disease measures, elevated creatinine remained a significant predictor of all-cause and cardiovascular mortality, total cardiovascular disease (CVD), claudication, and congestive heart failure (CHF). A linear increase in risk was observed with increasing creatinine.

CONCLUSIONS: Elevated creatinine levels are common in older adults and are associated with increased risk of mortality, CVD, and CHF. The increased risk is apparent early in renal disease.

10aAged10aCardiovascular Diseases10aConfidence Intervals10aCreatinine10aFemale10aHeart Failure10aHumans10aIntermittent Claudication10aKidney Failure, Chronic10aMale10aOdds Ratio10aPredictive Value of Tests10aSurvival Analysis1 aFried, Linda, F1 aShlipak, Michael, G1 aCrump, Casey1 aBleyer, Anthony, J1 aGottdiener, John, S1 aKronmal, Richard, A1 aKuller, Lewis, H1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/735