02977nas a2200373 4500008004100000022001400041245011400055210006900169260001300238300001200251490000700263520191600270653000902186653002202195653002802217653001502245653001302260653002302273653001102296653001102307653001102318653002002329653000902349653001202358653003202370100002402402700002402426700003202450700002202482700002502504700002002529700001902549856003502568 2004 eng d a1046-667300aModerate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study.0 aModerate renal impairment and risk of dementia among older adult c2004 Jul a1904-110 v153 a

Renal impairment is associated with an increased risk of carotid atherosclerosis and stroke, determinants of cognitive dysfunction and dementia. The purpose of this study was to determine whether moderate renal impairment is associated with incident dementia among community-dwelling older adults. Participants in the Cardiovascular Health Cognition Study without prevalent dementia (n = 3349) were included in the analysis. Incident dementia was confirmed through neurologic testing. Renal function at baseline was estimated by the inverse of serum creatinine (1/SCr); moderate renal impairment was defined as SCr > or = 1.3 mg/dl for women and > or = 1.5 mg/dl for men. Cox regression models were used to estimate the association of renal impairment with incident dementia. Because SCr is also a function of muscle mass, the authors determined whether the relationship between SCr and dementia was particularly strong among individuals without severe co-morbidity at baseline, as reflected by self-reported general health status. There were 477 incident dementia cases over a median 6 yr follow-up. After adjustment for potential confounders, moderate renal insufficiency was associated with a 37% increased risk of dementia (95% CI = 1.06 to 1.78). Similarly, a 0.5-unit decrement in 1/SCr (equivalent to an increase in SCr from 1.0 to 2.0 mg/dl) was associated with a 26% increased risk (95% CI = 1.02 to 1.60). These associations were present only among the 84% of older adults who reported good-excellent health. Among those in good-excellent health, higher SCr was associated with vascular-type dementia but not Alzheimer-type dementia. Moderate renal impairment, reflected by a higher SCr, is associated with an excess risk of incident dementia among individuals in good-excellent health. Strategies to prevent or delay the onset of dementia in patients with moderate renal impairment are needed.

10aAged10aAlzheimer Disease10aCardiovascular Diseases10aCreatinine10aDementia10aDementia, Vascular10aFemale10aHumans10aKidney10aKidney Diseases10aMale10aMuscles10aProportional Hazards Models1 aSeliger, Stephen, L1 aSiscovick, David, S1 aStehman-Breen, Catherine, O1 aGillen, Daniel, L1 aFitzpatrick, Annette1 aBleyer, Anthony1 aKuller, Lew, H uhttps://chs-nhlbi.org/node/79503889nas 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/831