Mild renal insufficiency and risk of congestive heart failure in men and women ≥70 years of age

doi:10.1016/S0002-9149(03)00822-1

The American Journal of Cardiology

Volume 92, Issue 6, 15 September 2003, Pages 682-686

https://doi.org/10.1016/S0002-9149(03)00822-1 Get rights and content

Abstract

Mild renal insufficiency is increasingly recognized as an independent risk factor for cardiovascular disease. However, few data exist regarding its relation to risk of congestive heart failure (CHF), a major public health problem in the elderly. To determine if mild renal insufficiency is associated with risk of incident CHF in the elderly, we analyzed data from 3,618 participants in the prospective, community-based Established Populations for Epidemiologic Studies of the Elderly (EPESE), who had no known CHF and had serum creatinine levels measured from 1987 to 1989. Mean age of the study population was 78.3 ± 5.4 years; 84% had creatinine values <1.5 mg/dl and 98% had creatinine values ≤2.0 mg/dl. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation. During 3.9 years of follow-up, 488 subjects developed incident CHF as defined by hospital discharge and death certificate data. In a multivariate proportional hazards model, CrCl was inversely associated with CHF risk (p value for trend <0.001). Those in the lowest quartile of CrCl (≤36.9 ml/min) had a nearly twofold (hazards ratio [HR] 1.99, 95% confidence intervals [CI] 1.43 to 2.79) greater risk of incident CHF compared with those in the highest quartile (>57.4 ml/min). Renal insufficiency, defined as creatinine ≥1.5 mg/dl in men and ≥1.3 mg/dl in women, was also associated with increased CHF risk (multivariate HR 1.43, 95% CI 1.17 to 1.74). Thus, mild renal insufficiency was a strong independent predictor of CHF in this cohort, suggesting that serum creatinine may offer a readily accessible tool to identify elderly patients at risk for CHF.

Section snippets

Methods

The methods of the EPESE have been published elsewhere.10 In brief, from 1981 to 1982, participants aged ≥65 years were recruited using population surveys in East Boston, Massachusetts, Iowa and Washington counties in Iowa, and from a stratified (by housing type and gender) random sample of residents in New Haven, Connecticut. Baseline participation rates were 80% to 85%. Trained interviewers conducted in-home examinations from 1981 to 1983, 1984 to 1986, and 1987 to 1989, and telephone

Results

The mean ± SD serum creatinine for the 3,618 participants was 1.2 ± 0.3 mg/dl; 84% had creatinine values <1.5 mg/dl and 98% had creatinine values ≤2.0 mg/dl. The mean CrCl was 48.1 ± 16.2 ml/min.

Baseline characteristics by quartile of CrCl are listed in Table 1. Decreased renal function was associated with increasing age, pulse pressure, and prevalence of hypertension, antihypertensive medication use, valvular heart disease (all p <0.001), and coronary heart disease (p = 0.0014). Those with

Discussion

In these prospective data in a community-based cohort of elderly subjects, we found a strong independent association between mild renal insufficiency, as assessed by either calculated CrCl or measured serum creatinine, and risk of incident CHF. After multivariate adjustment, those in the lowest quartile of CrCl (≤36.9 ml/min) had a nearly twofold greater risk of incident CHF compared with those in the highest quartile (CrCl >57.4 ml/min). These observations suggest that the adverse effects of

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^☆: Dr. Chae was supported by a Mentored Clinical Scientist Development Award (K08-HL-04154) from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. This study was supported by contract AG1027 from the National Institute on Aging, Bethesda, Maryland.

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Mild renal insufficiency and risk of congestive heart failure in men and women ≥70 years of age☆

Abstract

Section snippets

Methods

Results

Discussion

Am J Kidney Dis

Am J Kidney Dis

J Am Coll Cardiol

Am J Cardiol

J Am Coll Cardiol

Am J Kidney Dis

J Am Coll Cardiol

Kidney Int

Am J Cardiol

J Clin Epidemiol

Kidney Int

Chronic renal failure—a vasculopathic state

N Engl J Med

Cardiac structure and function in renal disease

Curr Opin Nephrol Hypertens

Mild renal insufficiency is associated with angiographic coronary artery disease in women

Circulation