Chronic kidney disease (CKD) could earn a spot near “previous heart attack” on the list of criteria defining people at highest risk of future coronary events, suggest the findings of a study led by Marcello Tonelli, MD, and described in Lancet.
In a population-based cohort of more than 1.2 million persons with measures of estimated glomerular filtration rate (eGFR) and proteinuria, 11,340 were hospitalized with an MI during a median follow-up of 48 months. The unadjusted MI rate was highest in those with previous MI (18.5 per 1,000 person-years). Among people without previous MI, the rate of MI was higher in those with CKD but without diabetes (6.9 per 1,000 person-years) than in those with diabetes but without CKD (5.4 per 1,000 person-years). The rate of incident MI in people with diabetes (6.6 per 1,000 person-years) was substantially lower than the rate among those with CKD (12.4 per 1,000 person-years) when defined by eGFR of less than 45 mL/min/1.73m2 and severely increased proteinuria.
Another large study addressed the cardiovascular risk factor of even just slightly elevated blood glucose levels. Data from 80,522 individuals from Copenhagen, Denmark, showed that 14,155 patients developed ischemic heart disease (IHD) and 6,257 suffered an MI. Risks for both conditions rose with increasing nonfasting glucose levels. The hazard ratio for IHD in persons with nonfasting glucose levels of 198 mg/dL or higher compared with persons with levels below 90 mg/dL was 6.9 when adjusted for age and sex and 2.3 adjusted multifactorially. Corresponding values for MI were 9.2 and 4.8 (J Am Coll Cardiol. 2012;59:2356-2365).
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Finally, a review of four studies originally conducted in Sweden and a fifth study originally conducted in Finland demonstrated a link between moderate coffee consumption and a lower risk of heart failure. As Murray A. Mittleman, MD, DrPH, and colleagues reported online ahead of print in the journal Circulation Heart Failure, in 6,522 heart failure events among 140,220 men and women, an association emerged between moderate coffee consumption—the equivalent of approximately two typical 8-oz American coffees—and a risk of heart failure up to 11% lower than the risk seen in non-coffee-drinkers. Excessive coffee consumption, however, conferred no protection against heart failure, and might even raise the risk.
