Renal insufficiency and cardiovascular events in postmenopausal women with coronary heart disease

J Am Coll Cardiol. 2001 Sep;38(3):705-11. doi: 10.1016/s0735-1097(01)01450-4.


Objectives: This study sought to determine the independent association of renal insufficiency with cardiovascular risk among women with known coronary heart disease (CHD).

Background: Although patients with end-stage renal disease and proteinuria are at high risk for cardiovascular events, little is known about the cardiovascular risk associated with moderate renal insufficiency.

Methods: The Heart and Estrogen/progestin Replacement Study (HERS) was a clinical trial among 2,763 women with coronary disease who were randomized to conjugated estrogen plus progestins or identical placebo and followed for a mean of 4.1 years. Women were categorized as having normal renal function (creatinine < 1.2 mg/dl; n = 2,012), mild renal insufficiency (1.2 mg/dl to 1.4 mg/dl; n = 567) and moderate renal insufficiency (>1.4 mg/dl; n = 182). We examined the independent association of renal function with incident cardiovascular events including CHD death, nonfatal myocardial infarction, hospitalization for unstable angina, stroke and transient ischemic attacks.

Results: Compared with women with normal renal function, those with mild and moderate renal insufficiency were older, more likely to be black, have a history of hypertension and diabetes and have higher serum levels of triglycerides and lipoprotein(a). After multivariate adjustment, both mild (relative hazards [RH] = 1.24; 95% confidence interval [CI]: 1.0 to 1.5) and moderate renal insufficiency (RH = 1.57; 95% CI: 1.2 to 2.1) were independently associated with increased risk for cardiovascular events compared with women with normal renal function.

Conclusions: Renal insufficiency is an independent risk factor for cardiovascular events in postmenopausal women with known coronary artery disease. Renal function may add helpful information to CHD risk stratification.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Comorbidity
  • Coronary Disease / blood
  • Coronary Disease / epidemiology*
  • Creatinine / blood
  • Female
  • Humans
  • Middle Aged
  • Postmenopause
  • Renal Insufficiency / blood
  • Renal Insufficiency / epidemiology*
  • Risk Assessment
  • Risk Factors


  • Creatinine