03261nas a2200397 4500008004100000022001400041245008400055210006900139260001300208300001300221490000700234520216800241653002102409653000902430653002102439653002102460653002102481653001502502653002802517653001102545653001102556653002802567653000902595653001502604653002402619653001702643100002402660700002002684700001702704700002302721700002102744700002202765700002102787700002002808856003502828 2002 eng d a0085-253800aCardiovascular disease risk status in elderly persons with renal insufficiency.0 aCardiovascular disease risk status in elderly persons with renal c2002 Sep a997-10040 v623 a

BACKGROUND: Renal insufficiency has been independently associated with incident cardiovascular disease events in some, but not all, prospective studies. We determined the prevalence of elevated cardiovascular disease risk status among elderly persons with renal insufficiency.

METHODS: This study is a cross-sectional analysis using data collected at the baseline visit of the Cardiovascular Health Study, which enrolled 5888 community dwelling adults aged 65 years or older from four clinical centers in the United States. Renal insufficiency was defined as a serum creatinine level > or =1.3 mg/dL in women and > or =1.5 mg/dL in men. The outcomes of this study included prevalent cardiovascular disease [prior coronary heart disease (CHD) or stroke], subclinical cardiovascular disease (abnormal values of ankle-arm index, carotid ultrasound, and echocardiography) and elevated cardiovascular risk based upon a diagnosis of diabetes and the Framingham equations. The association between renal insufficiency and cardiovascular risk status was estimated with and without adjustment for other cardiovascular predictors.

RESULTS: Among the 5808 participants with creatinine levels measured at entry, 15.9% of men (N = 394), and 7.6% of women (N = 254) had renal insufficiency. The prevalence of either clinical or subclinical cardiovascular disease was 64% in persons with renal insufficiency compared with 43% in those without it [odds ratio (OR) 2.34; 95% confidence interval (95% CI), 1.96, 2.80]. After adjustment for other cardiovascular risk factors, renal insufficiency remained significantly associated with clinical and subclinical cardiovascular disease (adjusted OR 1.43; 95% CI, 1.18, 1.75), but the magnitude of association was substantially reduced. After combining clinical and subclinical cardiovascular disease, diabetes, and an estimated risk>20% by the Framingham equations, 78% of men and 61% of women with renal insufficiency had elevated cardiovascular risk status.

CONCLUSIONS: Renal insufficiency is a marker for elevated cardiovascular disease risk in community dwelling elderly adults.

10aAge Distribution10aAged10aCholesterol, HDL10aCholesterol, LDL10aCoronary Disease10aCreatinine10aCross-Sectional Studies10aFemale10aHumans10aKidney Failure, Chronic10aMale10aPrevalence10aProspective Studies10aRisk Factors1 aShlipak, Michael, G1 aFried, Linda, F1 aCrump, Casey1 aBleyer, Anthony, J1 aManolio, Teri, A1 aTracy, Russell, P1 aFurberg, Curt, D1 aPsaty, Bruce, M uhttps://chs-nhlbi.org/node/69703258nas a2200421 4500008004100000022001400041245016200055210006900217260001300286300001100299490000800310520205700318653000902375653002202384653001602406653001502422653001902437653002102456653002802477653001102505653001902516653001102535653000902546653003002555653000902585100001602594700001902610700002102629700001802650700002002668700001802688700002302706700001602729700001802745700002002763700001802783856003502801 2008 eng d a1879-148400aCardiovascular and mortality risk prediction and stratification using urinary albumin excretion in older adults ages 68-102: the Cardiovascular Health Study.0 aCardiovascular and mortality risk prediction and stratification  c2008 Apr a806-130 v1973 a

BACKGROUND: Elevated urinary albumin excretion (UAE) is associated with the risk of cardiovascular disease (CVD) and all-cause mortality. We tested the hypothesis that elevated UAE improves cardiovascular risk stratification in an elderly cohort aged 68-102 years.

METHODS: We evaluated UAE in 3112 participants of the Cardiovascular Health Study who attended the 1996-1997 examination and had median follow up of 5.4 years. Elevated UAE was defined as urinary albumin to creatinine ratio > or =30 microg/mg. Microalbuminuria and macroalbuminuria were defined as urinary albumin to creatinine ratio 30-300 microg/mg and >300 microg/mg, respectively. Outcomes included CVD (myocardial infarction, stroke, cardiovascular death) and all-cause mortality. Cox proportional hazards models were used to assess the risk of outcomes associated with elevated UAE.

RESULTS: The prevalence of elevated UAE was 14.3%, 17.1% and 26.9% in those aged 68-74, 75-84 and 85-102 years, respectively. CVD incidence and all-cause mortality were doubled (7.2% and 8.1% per year) in those with microalbuminuria and tripled (11.1% and 12.3% per year) in those with macroalbuminuria compared to those with normal UAE (3.3% and 3.8% per year). The increased CVD and mortality risks were observed in all age groups after adjustment for conventional risk factors. The adjusted population attributable risk percent of CVD and all-cause mortality for elevated UAE was 11% and 12%, respectively. When participants were cross-classified by UAE and Framingham Risk Score categories, the 5-year cumulative incidence of coronary heart disease among participants with elevated UAE and a 5-year predicted risk of 5-10% was 20%, substantially higher than 6.3% in those with UAE <30m microg/mg.

CONCLUSION: Elevated UAE was associated with an increased risk of CVD and all-cause mortality in all age groups from 68 to 102 years. Combining elevated UAE with the Framingham risk scores may improve risk stratification for CVD in the elderly.

10aAged10aAged, 80 and over10aAlbuminuria10aBiomarkers10aCohort Studies10aCoronary Disease10aCross-Sectional Studies10aFemale10aHealth Surveys10aHumans10aMale10aPredictive Value of Tests10aRisk1 aCao, Jie, J1 aBiggs, Mary, L1 aBarzilay, Joshua1 aKonen, Joseph1 aPsaty, Bruce, M1 aKuller, Lewis1 aBleyer, Anthony, J1 aOlson, Jean1 aWexler, Jason1 aSummerson, John1 aCushman, Mary uhttps://chs-nhlbi.org/node/983