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CAC and Risk of CVD in Patients with CKD

JAMA Cardiol; ePub 2017 Mar 22; Chen, Budoff, et al

Coronary artery calcification (CAC) in patients with chronic kidney disease (CKD) is significantly and independently associated with risks of cardiovascular disease (CVD), myocardial infarction (MI), and heart failure (HF), a recent study found. The Chronic Renal Insufficiency cohort study included 1,541 participants aged 21 to 74 years without CVD at baseline who had CAC scores. It examined the prospective association of CAC with risk of CVD and all-cause mortality among dialysis-naïve patients with CKD. Researchers found:

  • There were 188 CVD events (120 HFs, 60 MIs, and 27 strokes) and 137 all-cause deaths during an average follow-up of 5.9 years.
  • 1 SD log higher in CAC score was significantly associated with a 40% higher risk of CVD, a 44% higher risk of MI, and a 39% higher risk of HF after adjusting for risk factors.
  • CAC improves risk prediction for CVD, MI, and HF over use of established CVD risk factors among patients with CKD.

Citation:

Chen J, Budoff MJ, Reilly MP, for the CRIC Investigators. Coronary artery calcification and risk of cardiovascular disease and death among patients with chronic kidney disease. [Published online ahead of print March 22, 2017]. JAMA Cardiol. doi:10.1001/jamacardio.2017.0363.

Commentary:

The results of this study show that CAC assessment can improve the predication of risk of CAD in patients with CKD. The challenging question is how to use this information. Many patients, particularly older patients, with CKD already qualify for treatment with a statin based on the standard AHA risk predication score. The incremental benefit of assessing CAC in these patients would be small because the CAC score would not lead to any change in medications. CAC assessment occupies the same space for patients with CKD that it does for patients in general—it may help clarify risk for patients who are at intermediate risk when both patient and physician feel that the benefit-risk ratio for starting a statin is unclear. Thus, further delineation of risk may be helpful. —Neil Skolnik, MD