The Prevalence of Nontraditional Risk Factors for Coronary Heart Disease in Patients With Chronic Kidney Disease

Ann Intern Med. 2004 Jan 6;140(1):9-17. doi: 10.7326/0003-4819-140-1-200401060-00006.

Abstract

Background: Risk for coronary heart disease is high among patients with chronic kidney disease.

Objective: To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR).

Design: Cross-sectional study.

Setting: Third National Health and Nutrition Examination survey.

Participants: 12 547, 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m2, respectively, who were at least 18 years of age.

Measurements: Chronic kidney disease was defined as an estimated GFR of less than 60 mL/min per 1.73 m2 based on the abbreviated Modification of Diet in Renal Disease formula.

Results: After standardization for age, race or ethnicity, and sex, lower estimated GFR (> or =90, 60 to 89, or <60 mL/min per 1.73 m2) was associated with lower average levels of apolipoprotein A1 (1.44, 1.43, and 1.35 g/L) and higher levels of apolipoprotein B (1.03, 1.06, and 1.08 g/L), plasma fibrinogen (8.43, 8.44, and 9.53 micromol/L), homocysteine (8.5, 10.0, and 13.2 micromol/L), and C-reactive protein (3.0, 2.9, and 3.9 mg/L) (P < 0.05 for all values). The multivariate-adjusted odds ratios of an apolipoprotein A1 level of less than 1.2 g/L, a serum lipoprotein(a) level of at least 1.61 micromol/L (> or =45.3 mg/dL), a plasma fibrinogen level of at least 10.35 micromol/L, a serum homocysteine level of at least 15 micromol/L, and a C-reactive protein level of at least 10.0 mg/L for participants with chronic kidney disease compared with those with a GFR of at least 90 mL/min per 1.73 m2 or greater were 1.92 (95% CI, 1.02 to 3.63), 1.82 (CI, 1.06 to 3.13), 1.74 (CI, 1.35 to 2.24), 8.23 (CI, 5.00 to 13.6), and 1.93 (CI, 1.33 to 2.81), respectively.

Conclusions: Levels of apolipoprotein A1 are decreased and levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein are increased among patients with chronic kidney disease.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Apolipoprotein A-I / blood
  • Apolipoproteins B / blood
  • C-Reactive Protein / metabolism
  • Chronic Disease
  • Coronary Disease / etiology*
  • Cross-Sectional Studies
  • Female
  • Fibrinogen / metabolism
  • Glomerular Filtration Rate
  • Homocysteine / blood
  • Humans
  • Kidney Diseases / blood*
  • Kidney Diseases / complications*
  • Lipoprotein(a) / blood
  • Male
  • Middle Aged
  • Risk Factors

Substances

  • Apolipoprotein A-I
  • Apolipoproteins B
  • Lipoprotein(a)
  • Homocysteine
  • Fibrinogen
  • C-Reactive Protein