Clinical and subclinical cardiovascular disease and kidney function decline in the elderly

Atherosclerosis. 2009 May;204(1):298-303. doi: 10.1016/j.atherosclerosis.2008.08.016. Epub 2008 Aug 26.


Objective: Kidney function decline in elderly persons may be the result of microvascular atherosclerosis. As a proxy for the renovascular system, we evaluated the association of clinical and subclinical cardiovascular disease (CVD) with kidney function decline.

Methods: This study included 4380 subjects from the Cardiovascular Health Study, a longitudinal, community-based cohort of persons aged >or=65 from 4 U.S. communities. Creatinine and cystatin C were measured at baseline, year 3, and year 7; eligible subjects had at least two measures. Creatinine-based estimated glomerular filtration rate (eGFR(creat)) was calculated using the MDRD equation. Rapid kidney function decline was defined as an annual eGFR loss >3 mL/min/1.73 m(2). Predictors of rapid kidney decline included prevalent and subclinical measures of CVD.

Results: Mean decline in eGFR(creat) was 0.4+/-2.6/year; 714 (16%) had rapid progression. In multivariate models adjusted for demographics, cardiovascular risk factors, and inflammation, prevalent stroke (OR, 95% CI: 1.55, 1.16-2.08) and heart failure (OR, 95% CI: 1.80, 1.40-2.31) were independent predictors of rapid kidney decline. Among persons without clinical CV, the subclinical disease measures ankle-arm index <0.9 (OR, 95% CI: 1.67, 1.25-2.24), common carotid intima-media thickness (>or=1.14 mm) (OR, 95% CI: 1.52, 1.12-2.06) and internal carotid intima-media thickness (>1.82 mm) (OR, 95% CI: 1.50, 1.12-2.02) had independent associations with rapid kidney function decline. Results were similar using cystatin C.

Conclusion: Clinical atherosclerosis and heart failure and subclinical measures of CVD have independent associations with kidney function decline progression in the elderly, suggesting an underlying role of renal atherosclerosis.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Age Factors
  • Aged
  • Atherosclerosis / complications
  • Atherosclerosis / physiopathology
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / pathology
  • Cardiovascular Diseases / physiopathology
  • Creatinine / blood
  • Cystatin C / blood
  • Female
  • Glomerular Filtration Rate*
  • Heart Failure / complications
  • Heart Failure / physiopathology
  • Humans
  • Kidney / physiopathology*
  • Kidney Diseases / etiology*
  • Kidney Diseases / physiopathology
  • Linear Models
  • Longitudinal Studies
  • Male
  • Odds Ratio
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • United States


  • CST3 protein, human
  • Cystatin C
  • Creatinine