03224nas a2200493 4500008004100000022001400041245017200055210006900227260001300296300001000309490000700319520182100326653002102147653000902168653002202177653001602199653001502215653002002230653001602250653002102266653002802287653002202315653001102337653001102348653001702359653001702376653002002393653000902413653002602422653001502448653001702463653001202480653002002492100002402512700001702536700001802553700002302571700001602594700002002610700002202630700001802652700002502670856003502695 2004 eng d a1523-683800aThe relationship of cardiovascular risk factors to microalbuminuria in older adults with or without diabetes mellitus or hypertension: the cardiovascular health study.0 arelationship of cardiovascular risk factors to microalbuminuria  c2004 Jul a25-340 v443 a

BACKGROUND: Microalbuminuria is a risk factor for coronary heart disease (CHD). It occurs most commonly in the settings of diabetes and hypertension. The mechanisms by which it increases CHD risk are uncertain.

METHODS: We examined the cross-sectional association of microalbuminuria with a broad range of CHD risk factors in 3 groups of adults aged 65 years or older with and without microalbuminuria: those with (1) no diabetes or hypertension (n = 1,098), (2) hypertension only (n = 1,450), and (3) diabetes with or without hypertension (n = 465).

RESULTS: Three factors were related to microalbuminuria in all 3 groups: age, elevated systolic blood pressure, and markers of systemic inflammation. In patients with neither diabetes nor hypertension, increasing C-reactive protein levels were associated with microalbuminuria (odds ratio per 1-mg/L increase, 1.46; 95% confidence interval [CI], 1.15 to 1.84). Among those with diabetes, an increase in white blood cell (WBC) count was associated with microalbuminuria (odds ratio per 1,000-cell/mL increase, 2.57; 95% CI, 1.12 to 5.89). Among those with hypertension, an increase in WBC count (odds ratio per 1,000-cell/mL increase, 1.83; 95% CI, 1.04 to 3.23) and fibrinogen level (odds ratio per 10-mg/dL increase, 1.02; 95% CI, 1.00 to 1.05) were significantly associated with microalbuminuria. In all 3 groups, prevalent CHD was related to an elevated WBC count. In none of the 3 groups was brachial artery reactivity to ischemia, an in vivo marker of endothelial function, related to microalbuminuria.

CONCLUSION: Microalbuminuria is associated with age, systolic blood pressure, and markers of inflammation. These associations reflect potential mechanisms by which microalbuminuria is related to CHD risk.

10aAge Distribution10aAged10aAged, 80 and over10aAlbuminuria10aBiomarkers10aBrachial Artery10aComorbidity10aCoronary Disease10aCross-Sectional Studies10aDiabetes Mellitus10aFemale10aHumans10aHypertension10aInflammation10aLogistic Models10aMale10aMultivariate Analysis10aOdds Ratio10aRisk Factors10aSmoking10aUltrasonography1 aBarzilay, Joshua, I1 aPeterson, Do1 aCushman, Mary1 aHeckbert, Susan, R1 aCao, Jie, J1 aBlaum, Caroline1 aTracy, Russell, P1 aKlein, Ronald1 aHerrington, David, M uhttps://chs-nhlbi.org/node/79403889nas a2200337 4500008004100000022001400041245011100055210006900166260001600235300001200251490000800263520291100271653000903182653002803191653002003219653001103239653002003250653002503270653001703295100002403312700002003336700001803356700002103374700001703395700002903412700002003441700001703461700002103478700001703499856003503516 2005 eng d a1538-359800aCardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors.0 aCardiovascular mortality risk in chronic kidney disease comparis c2005 Apr 13 a1737-450 v2933 a

CONTEXT: Elderly persons with chronic kidney disease have substantial risk for cardiovascular mortality, but the relative importance of traditional and novel risk factors is unknown.

OBJECTIVE: To compare traditional and novel risk factors as predictors of cardiovascular mortality.

DESIGN, SETTING, AND PATIENTS: A total of 5808 community-dwelling persons aged 65 years or older living in 4 communities in the United States participated in the Cardiovascular Health Study cohort. Participants were initially recruited from 1989 to June 1990; an additional 687 black participants were recruited in 1992-1993. The average length of follow-up in this longitudinal study was 8.6 years.

MAIN OUTCOME MEASURES: Cardiovascular mortality among those with and without chronic kidney disease. Chronic kidney disease was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2.

RESULTS: Among the participants, 1249 (22%) had chronic kidney disease at baseline. The cardiovascular mortality risk rate was 32 deaths/1000 person-years among those with chronic kidney disease vs 16/1000 person-years among those without it. In multivariate analyses, diabetes, systolic hypertension, smoking, low physical activity, nonuse of alcohol, and left ventricular hypertrophy were predictors of cardiovascular mortality in persons with chronic kidney disease (all P values <.05). Among the novel risk factors, only log C-reactive protein (P = .05) and log interleukin 6 (P<.001) were associated with the outcome as linear predictors. Traditional risk factors were associated with the largest absolute increases in risks for cardiovascular deaths among persons with chronic kidney disease: for left ventricular hypertrophy, there were 25 deaths per 1000 person-years; current smoking, 20 per 1000 person-years; physical inactivity, 15 per 1000 person-years; systolic hypertension, 14 per 1000 person-years; diabetes, 14 per 1000 person-years; and nonuse of alcohol, 11 per 1000 person-years vs 5 deaths per 1000 person-years for those with increased C-reactive protein and 5 per 1000 person-years for those with increased interleukin 6 levels. A receiver operating characteristic analysis found that traditional risk factors had an area under the curve of 0.73 (95% confidence interval, 0.70-0.77) among those with chronic kidney disease. Adding novel risk factors only increased the area under the curve to 0.74 (95% confidence interval, 0.71-0.78; P for difference = .15).

CONCLUSIONS: Traditional cardiovascular risk factors had larger associations with cardiovascular mortality than novel risk factors in elderly persons with chronic kidney disease. Future research should investigate whether aggressive lifestyle intervention in patients with chronic kidney disease can reduce their substantial cardiovascular risk.

10aAged10aCardiovascular Diseases10aChronic Disease10aHumans10aKidney Diseases10aLongitudinal Studies10aRisk Factors1 aShlipak, Michael, G1 aFried, Linda, F1 aCushman, Mary1 aManolio, Teri, A1 aPeterson, Do1 aStehman-Breen, Catherine1 aBleyer, Anthony1 aNewman, Anne1 aSiscovick, David1 aPsaty, Bruce uhttps://chs-nhlbi.org/node/83103064nas a2200433 4500008004100000022001400041245015800055210006900213260001300282300001000295490000800305520182700313653000902140653002202149653001602171653002002187653002802207653002102235653002202256653001102278653001102289653001702300653000902317653003302326653001502359653001702374653001102391653001802402100001602420700002402436700001702460700002102477700002002498700001802518700001802536700002302554700001802577856003502595 2006 eng d a0021-915000aThe association of microalbuminuria with clinical cardiovascular disease and subclinical atherosclerosis in the elderly: the Cardiovascular Health Study.0 aassociation of microalbuminuria with clinical cardiovascular dis c2006 Aug a372-70 v1873 a

PURPOSE: Microalbuminuria (MA) is a risk factor for cardiovascular disease (CVD). It is not known whether this association is due to the effect of MA on the development of subclinical atherosclerosis or whether MA destabilizes subclinical atherosclerosis, leading to clinical events.

METHODS: In a cross-sectional analysis we evaluated 3312 Cardiovascular Health Study participants, age >or=65 years, who had MA testing. Participants were divided into three groups: those without diabetes or hypertension (33%), those with hypertension (52%) and those with diabetes, with or without hypertension (15%). Clinical CVD was defined as presence of coronary heart disease (angina, MI, CABG, PTCA), cerebrovascular disease (stroke, TIA) and peripheral arterial disease (requiring intervention). Among those without clinical disease, subclinical atherosclerosis was defined as increased carotid artery intima-media thickness, decreased ankle arm index or increased left ventricular mass.

RESULTS: In each of the three groups of participants, the adjusted odds of prevalent clinical CVD in the presence of MA was 1.70-1.80-fold increased, independent of other risk factors. MA was not associated with risk of subclinical atherosclerosis in those without hypertension or diabetes (OR 1.14 [95% CI 0.59, 2.23]), whereas it was associated with subclinical atherosclerosis in those with hypertension (OR 1.58 [95% CI 1.08, 2.30]) or diabetes (OR 2.51 [95% CI 1.27, 4.94]).

CONCLUSION: In the absence of hypertension or diabetes, MA was associated with clinical CVD but not with subclinical atherosclerosis. Thus, a hypothesis may be made that the mechanism of association of MA with clinical vascular disease involves destabilization of the vasculature, leading to clinical disease.

10aAged10aAged, 80 and over10aAlbuminuria10aAtherosclerosis10aCardiovascular Diseases10aCoronary Disease10aDiabetes Mellitus10aFemale10aHumans10aHypertension10aMale10aPeripheral Vascular Diseases10aPrevalence10aRisk Factors10aStroke10aUnited States1 aCao, Jie, J1 aBarzilay, Joshua, I1 aPeterson, Do1 aManolio, Teri, A1 aPsaty, Bruce, M1 aKuller, Lewis1 aWexler, Jason1 aBleyer, Anthony, J1 aCushman, Mary uhttps://chs-nhlbi.org/node/863