Estimated kidney function based on serum cystatin c and risk of subsequent coronary artery calcium in young and middle-aged adults with preserved kidney function: Results from the CARDIA study

Nisha Bansal, Eric Vittinghoff, Carmen A. Peralta, Michael G. Shlipak, Vanessa Grubbs, David R. Jacobs, David Siscovick, Michael Steffes, John Jeffrey Carr, Kirsten Bibbins-Domingo

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Whether kidney dysfunction is associated with coronary artery calcium (CAC) in young and middle-aged adults who have a cystatin C-derived estimated glomerular filtration rate (eGFRcys) greater than 60 mL/min/1.73 m2 is unknown. In the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (recruited in 1985 and 1986 in Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California), we examined 1) the association of eGFRcys at years 10 and 15 and detectable CAC over the subsequent 5 years and 2) the association of change in eGFRcys and subsequent CAC, comparing those with stable eGFRcys to those whose eGFRcys increased (>3% annually over 5 years), declined moderately (3%-5%), or declined rapidly (>5%). Generalized estimating equation Poisson models were used, with adjustment for age, sex, race, educational level, income, family history of coronary artery disease, diabetes, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and tobacco use. Among 3,070 participants (mean age 35.6 (standard deviation, 4.1) years and mean eGFRcys 106.7 (standard deviation, 18.5) mL/min/1.73 m2), 529 had detectable CAC. Baseline eGFRcys was not associated with CAC. Moderate eGFRcys decline was associated with a 33% greater relative risk of subsequent CAC (95% confidence interval: 5, 68; P = 0.02), whereas rapid decline was associated with a 51% higher relative risk (95% confidence interval: 10, 208; P = 0.01) in adjusted models. In conclusion, among young and middle-aged adults with eGFRcys greater than 60 mL/min/1.73 m2, annual decline in eGFRcys is an independent risk factor for subsequent CAC.

Original languageEnglish (US)
Pages (from-to)410-417
Number of pages8
JournalAmerican journal of epidemiology
Volume178
Issue number3
DOIs
StatePublished - Aug 1 2013

Keywords

  • calcification
  • cardiovascular diseases
  • chronic kidney insufficiency
  • coronary arteries
  • coronary disease
  • cystatin C
  • glomerular filtration rate
  • kidney

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