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Cardiac and kidney markers for cardiovascular prediction in individuals with chronic kidney disease: the Atherosclerosis Risk in Communities study.
- Source :
-
Arteriosclerosis, thrombosis, and vascular biology [Arterioscler Thromb Vasc Biol] 2014 Aug; Vol. 34 (8), pp. 1770-7. Date of Electronic Publication: 2014 May 29. - Publication Year :
- 2014
-
Abstract
- Objective: Traditional predictors suboptimally predict cardiovascular disease (CVD) in individuals with chronic kidney disease (CKD). This study compared 5 nontraditional cardiac and kidney markers on the improvement of cardiovascular prediction among those with CKD.<br />Approach and Results: Among 8622 participants aged 52 to 75 years in the Atherosclerosis Risk in Communities (ARIC) Study, cardiac troponin T, N-terminal pro-B-type natriuretic peptide, cystatin C, β2-microglobulin, and β-trace protein were compared for improvement in predicting incident CVD after stratifying by CKD status (940 participants with CKD [kidney dysfunction or albuminuria]). During a median follow-up of 11.9 years, there were 1672 CVD events including coronary disease, stroke, and heart failure (336 cases in CKD). Every marker was independently associated with incident CVD in participants with and without CKD. The adjusted hazard ratios (per 1 SD) were larger for cardiac markers than for kidney markers, particularly in CKD (1.61 [95% confidence interval, 1.43-1.81] for cardiac troponin T, 1.50 [1.34-1.68] for N-terminal pro-B-type natriuretic peptide, and <1.26 for kidney markers). Particularly in CKD group, cardiac markers compared with kidney markers contributed to greater c-statistic increment (0.032-0.036 versus 0.012-0.015 from 0.679 with only conventional predictors in CKD and 0.008-0.011 versus 0.002-0.010 from 0.697 in non-CKD) and categorical net reclassification improvement (0.086-0.127 versus 0.020-0.066 in CKD and 0.057-0.077 versus 0.014-0.048 in non-CKD). The superiority of cardiac markers was largely consistent in individual CVD outcomes.<br />Conclusions: A greater improvement in cardiovascular prediction was observed for cardiac markers than for kidney markers in people with CKD. These results suggest that cardiac troponin T and N-terminal pro-B-type natriuretic peptide are useful for better CVD risk classification in this population.<br /> (© 2014 American Heart Association, Inc.)
- Subjects :
- Aged
Biomarkers blood
Cardiovascular Diseases diagnosis
Cardiovascular Diseases epidemiology
Cystatin C blood
Female
Humans
Incidence
Intramolecular Oxidoreductases blood
Lipocalins blood
Male
Middle Aged
Natriuretic Peptide, Brain blood
Peptide Fragments blood
Predictive Value of Tests
Prognosis
Renal Insufficiency, Chronic diagnosis
Renal Insufficiency, Chronic epidemiology
Risk Assessment
Risk Factors
Time Factors
Troponin T blood
United States epidemiology
beta 2-Microglobulin blood
Cardiovascular Diseases blood
Renal Insufficiency, Chronic blood
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4636
- Volume :
- 34
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Arteriosclerosis, thrombosis, and vascular biology
- Publication Type :
- Academic Journal
- Accession number :
- 24876355
- Full Text :
- https://doi.org/10.1161/ATVBAHA.114.303465