| Department of Medicine, Hadassah University Hospital, Mount Scopus,
Jerusalem, Cardiac Rehabilitation Institute and Department of Medicine
D, Sheba Medical Center, Tel-Hashomer, Israel |
SUMMARY: OBJECTIVE To examine the effect of mild renal dysfunction
on coronary artery calcifications.METHODS We examined the progression
of coronary atherosclerosis, as measured by dual-section spiral computed
tomography, using the total coronary artery calcium score as a quantitative
measure of the burden of atherosclerosis. Of 547 high-risk Israeli
hypertensive patients, who were participants of the prospective calcification
study (a side-arm of the international INSIGHT study), 313 patients
completed the 3-year follow-up. Subjects were studied upon entry (on
placebo) and again after 3 years of treatment (nifedipine or thiazide).
Patients were divided into two groups depending on their creatinine
clearance: (i) </= and (ii) (n="53)" (RD) dysfunction
renal min, ml 60>60 ml/min, normal renal function group (n = 263).RESULTS
Blood pressure, hypercholesterolemia, and smoking did not differ between
the groups. After 3 years of treatment, blood pressure control was
similar, whereas the total coronary artery calcium score progression
was two-fold greater in the RD than the normal group (156 +/- 32 versus
64 +/- 8, respectively) (P = 0.006). In a multiple logistic regression
analysis, the odds ratio (OR) for total coronary artery calcium score
progression was higher for the RD group (2.1) [95% confidence interval
(CI) 1.2-3.7]. Gender, body mass index, smoking, cholesterol, family
history of ischaemic heart disease and diabetes were not significant
predictors. Thiazide-based antihypertensive therapy predicted a faster
progression compared to nifedipine (OR 1.66, 95% CI 1.09-2.51).CONCLUSIONS
Mild renal dysfunction accelerates coronary artery calcifications,
above and beyond conventional risk factors.
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