Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome

Lisa M. Mielniczuk, Marc A. Pfeffer, Eldrin F. Lewis, Michael A. Blazing, James A de Lemos, Amy Shui, Satish Mohanavelu, Robert M. Califf, Eugene Braunwald

Research output: Contribution to journalArticle

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Abstract

Both renal dysfunction and elevated levels of high-sensitivity C-reactive protein (CRP) are associated with a higher risk of cardiovascular (CV) outcomes. However, it remains to be established whether the prognostic value of impaired estimated glomerular filtration rate (GFR) remains after accounting for markers of inflammation. Methods and Results: Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation in 4178 patients with non-ST or ST-elevation acute coronary syndromes, participating in the A to Z trial. The mean estimated GFR was 68 mL/min, with a median baseline CRP of 20.2 mg/L. Both an estimated GFR <60 mL/min (HR 2.13, 95% CI 1.7-2.6) and a CRP in the fourth quartile (HR 1.7, 95% CI 1.4-2.2) were strong univariate predictors of a CV event (composite of CV death, recurrent myocardial infarction, heart failure, or stroke). After adjusting for baseline CRP, GFR <60 mL/min remained a strong multivariate predictor for CV death (HR 1.82, 95% CI 1.1-2.97). Randomization to high-dose statin therapy was associated with a reduction in the CV composite (adjusted HR 0.69, 95% CI 0.5-0.95) irrespective of baseline renal function. Conclusions: In a population of patients without overt renal disease, moderate reductions in estimated GFR remain an important prognostic marker. This increased CV hazard associated with an estimated GFR <60 mL/min is independent and additive to markers of inflammation.

Original languageEnglish (US)
Pages (from-to)725-731
Number of pages7
JournalAmerican Heart Journal
Volume155
Issue number4
DOIs
StatePublished - Apr 2008

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Acute Coronary Syndrome
Glomerular Filtration Rate
Inflammation
C-Reactive Protein
Kidney
Diet Therapy
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Random Allocation
Heart Failure
Stroke
Myocardial Infarction
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome. / Mielniczuk, Lisa M.; Pfeffer, Marc A.; Lewis, Eldrin F.; Blazing, Michael A.; de Lemos, James A; Shui, Amy; Mohanavelu, Satish; Califf, Robert M.; Braunwald, Eugene.

In: American Heart Journal, Vol. 155, No. 4, 04.2008, p. 725-731.

Research output: Contribution to journalArticle

Mielniczuk, LM, Pfeffer, MA, Lewis, EF, Blazing, MA, de Lemos, JA, Shui, A, Mohanavelu, S, Califf, RM & Braunwald, E 2008, 'Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome', American Heart Journal, vol. 155, no. 4, pp. 725-731. https://doi.org/10.1016/j.ahj.2007.11.031
Mielniczuk, Lisa M. ; Pfeffer, Marc A. ; Lewis, Eldrin F. ; Blazing, Michael A. ; de Lemos, James A ; Shui, Amy ; Mohanavelu, Satish ; Califf, Robert M. ; Braunwald, Eugene. / Estimated glomerular filtration rate, inflammation, and cardiovascular events after an acute coronary syndrome. In: American Heart Journal. 2008 ; Vol. 155, No. 4. pp. 725-731.
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AU - Mohanavelu, Satish

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AB - Both renal dysfunction and elevated levels of high-sensitivity C-reactive protein (CRP) are associated with a higher risk of cardiovascular (CV) outcomes. However, it remains to be established whether the prognostic value of impaired estimated glomerular filtration rate (GFR) remains after accounting for markers of inflammation. Methods and Results: Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease equation in 4178 patients with non-ST or ST-elevation acute coronary syndromes, participating in the A to Z trial. The mean estimated GFR was 68 mL/min, with a median baseline CRP of 20.2 mg/L. Both an estimated GFR <60 mL/min (HR 2.13, 95% CI 1.7-2.6) and a CRP in the fourth quartile (HR 1.7, 95% CI 1.4-2.2) were strong univariate predictors of a CV event (composite of CV death, recurrent myocardial infarction, heart failure, or stroke). After adjusting for baseline CRP, GFR <60 mL/min remained a strong multivariate predictor for CV death (HR 1.82, 95% CI 1.1-2.97). Randomization to high-dose statin therapy was associated with a reduction in the CV composite (adjusted HR 0.69, 95% CI 0.5-0.95) irrespective of baseline renal function. Conclusions: In a population of patients without overt renal disease, moderate reductions in estimated GFR remain an important prognostic marker. This increased CV hazard associated with an estimated GFR <60 mL/min is independent and additive to markers of inflammation.

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