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QJM Advance Access originally published online on January 7, 2009
QJM 2009 102(3):183-191; doi:10.1093/qjmed/hcn171
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© The Author 2009. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Renal function is associated with arterial stiffness and predicts outcome in patients with coronary artery disease

B. Ilyas1, N. Dhaun1, D. Markie1, P. Stansell1, J. Goddard2, D.E. Newby3 and D.J. Webb1

From the 1Clinical Pharmacology Unit, University of Edinburgh, The Queen's Medical Research Institute, 2Department of Renal Medicine and 3Department of Cardiology, Royal Infirmary of Edinburgh, Edinburgh EH16 4TJ, UK

Address correspondence to Dr N. Dhaun, The Queen's Medical Research Institute, 3rd Floor East, Room E3.23, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK. email: bean.dhaun{at}ed.ac.uk

Received 30 June 2008 and in revised form 4 November 2008


  Abstract

Background: Arterial stiffness (AS) is associated, and a predictor of, outcome in patients with cardiovascular and renal disease.

Aim: In this study, we estimated glomerular filtration rate (eGFR) and measured indices of AS in patients with suspected coronary artery disease (CAD), and assessed their predictive value on outcome.

Design: Prospective cohort study.

Methods: AS was measured using pulse wave velocity (PWV) and pulse wave analysis in patients with no known renal disease who had recently undergone coronary angiography. Renal function was assessed using serum creatinine concentration [creat]sr and eGFR (Cockcroft & Gault, C&G). The primary endpoint was a combination of hospitalization due to cardiovascular disease and all-cause mortality.

Results: Two hundred eighty-four subjects (210 men, 74 women, mean age 62 years) were followed-up for a mean of 1.5 years. PWV was negatively associated with eGFR (r2 = 0.09, P < 0.001), even in patients with an eGFR >=60 ml/min/m2 (r2 = 0.04, P < 0.01). PWV was determined by age, heart rate, systolic blood pressure, body mass index and [creat]sr (r2 = 0.38, P < 0.001). A lower eGFR (P < 0.01), PWV above the median (P < 0.05) and degree of CAD (P < 0.001) predicted a shorter time to the primary endpoint. eGFR and degree of CAD remained independent determinants of outcomes (P < 0.01), even in patients with normal renal function (P < 0.01).

Conclusions: This study suggests that even minor reductions in eGFR, within the normal range, are an additional independent risk marker in patients with CAD.


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