TY - JOUR
T1 - Kidney Function and Cardiovascular Events in Postmenopausal Women
T2 - The Impact of Race and Ethnicity in the Women's Health Initiative
AU - Arce, Cristina M.
AU - Rhee, Jinnie J.
AU - Cheung, Katharine L.
AU - Hedlin, Haley
AU - Kapphahn, Kristopher
AU - Franceschini, Nora
AU - Kalil, Roberto S.
AU - Martin, Lisa W.
AU - Qi, Lihong
AU - Shara, Nawar M.
AU - Desai, Manisha
AU - Stefanick, Marcia L.
AU - Winkelmayer, Wolfgang C.
N1 - Funding Information:
Support: Dr Arce was supported by an under-represented minority supplement to T32DK007357. Dr Rhee was supported by T32DK007357 and F32DK103473. Dr Winkelmayer receives salary and research support through the endowed Gordon A. Cain Chair in Nephrology at Baylor College of Medicine. The WHI program is funded by the National Heart, Lung and Blood Institute , National Institutes of Health , US Department of Health and Human Services , through contracts HHSN268201100046C , HHSN268201100001C , HHSN268201100002C , HHSN268201100003C , HHSN268201100004C , and HHSN271201100004C .
Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background Kidney disease disproportionately affects minority populations, including African Americans and Hispanics; therefore, understanding the relationship of kidney function to cardiovascular (CV) outcomes within different racial/ethnic groups is of considerable interest. We investigated the relationship between kidney function and CV events and assessed effect modification by race/ethnicity in the Women's Health Initiative. Study Design Prospective cohort study. Setting & Participants Baseline serum creatinine concentrations (assay traceable to isotope-dilution mass spectrometry standard) of 19,411 postmenopausal women aged 50 to 79 years who self-identified as either non-Hispanic white (n = 8,921), African American (n = 7,436), or Hispanic (n = 3,054) were used to calculate estimated glomerular filtration rates (eGFRs). Predictors Categories of eGFR (exposure); race/ethnicity (effect modifier). Outcomes The primary outcome was the composite of 3 physician-adjudicated CV events: myocardial infarction, stroke, or CV-related death. Measurements We evaluated the multivariable-adjusted associations between categories of eGFR and CV events using proportional hazards regression and formally tested for effect modification by race/ethnicity. Results During a mean follow-up of 7.6 years, 1,424 CV events (653 myocardial infarctions, 627 strokes, and 297 CV-related deaths) were observed. The association between eGFR and CV events was curvilinear; however, the association of eGFR with CV outcomes differed by race (P = 0.006). In stratified analyses, we observed that the U-shaped association was present in non-Hispanic whites, whereas African American participants had a rather curvilinear relationship, with lower eGFR being associated with higher CV risk, and higher eGFR, with reduced CV risk. Analyses among Hispanic women were inconclusive owing to few Hispanic women having very low or high eGFRs and very few events occurring in these categories. Limitations Lack of urinary albumin measurements; residual confounding by unmeasured or imprecisely measured characteristics. Conclusions In postmenopausal women, the patterns of association between eGFR and CV risk differed between non-Hispanic whites and African American women.
AB - Background Kidney disease disproportionately affects minority populations, including African Americans and Hispanics; therefore, understanding the relationship of kidney function to cardiovascular (CV) outcomes within different racial/ethnic groups is of considerable interest. We investigated the relationship between kidney function and CV events and assessed effect modification by race/ethnicity in the Women's Health Initiative. Study Design Prospective cohort study. Setting & Participants Baseline serum creatinine concentrations (assay traceable to isotope-dilution mass spectrometry standard) of 19,411 postmenopausal women aged 50 to 79 years who self-identified as either non-Hispanic white (n = 8,921), African American (n = 7,436), or Hispanic (n = 3,054) were used to calculate estimated glomerular filtration rates (eGFRs). Predictors Categories of eGFR (exposure); race/ethnicity (effect modifier). Outcomes The primary outcome was the composite of 3 physician-adjudicated CV events: myocardial infarction, stroke, or CV-related death. Measurements We evaluated the multivariable-adjusted associations between categories of eGFR and CV events using proportional hazards regression and formally tested for effect modification by race/ethnicity. Results During a mean follow-up of 7.6 years, 1,424 CV events (653 myocardial infarctions, 627 strokes, and 297 CV-related deaths) were observed. The association between eGFR and CV events was curvilinear; however, the association of eGFR with CV outcomes differed by race (P = 0.006). In stratified analyses, we observed that the U-shaped association was present in non-Hispanic whites, whereas African American participants had a rather curvilinear relationship, with lower eGFR being associated with higher CV risk, and higher eGFR, with reduced CV risk. Analyses among Hispanic women were inconclusive owing to few Hispanic women having very low or high eGFRs and very few events occurring in these categories. Limitations Lack of urinary albumin measurements; residual confounding by unmeasured or imprecisely measured characteristics. Conclusions In postmenopausal women, the patterns of association between eGFR and CV risk differed between non-Hispanic whites and African American women.
KW - African American
KW - CV death
KW - CV events
KW - CV risk
KW - Cardiovascular disease (CVD)
KW - Hispanic
KW - Women's Health Initiative (WHI)
KW - estimated glomerular filtration rate (eGFR)
KW - kidney disease
KW - myocardial infarction (MI)
KW - race/ethnicity
KW - renal function
KW - serum creatinine
KW - stroke
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U2 - 10.1053/j.ajkd.2015.07.020
DO - 10.1053/j.ajkd.2015.07.020
M3 - Article
C2 - 26337132
AN - SCOPUS:84940705600
SN - 0272-6386
VL - 67
SP - 198
EP - 208
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -