In patients with new onset symptoms of coronary heart disease, a reduced
estimated glomerular filtration rate was associated with a greater likelihood
of presenting with acute MI vs. stable exertional angina, according to study
Patients were enrolled in the study if their first clinical presentation
of CHD was acute MI or stable exertional
angina between October 2001 and December 2003. Researchers
calculated estimated glomerular filtration rate (eGFR) before the incident
event with calibrated serum creatinine and the abbreviated Modification of Diet
in Renal Disease equation. Self-reports and health plan databases identified
patient characteristics and use of medications, and the association of reduced
eGFR and CHD presentation was examined by multivariable logistic regression,
according to researchers.
They found that patients with acute MI had a lower eGFR mean vs.
patients with stable angina. According to study results, there was an
association between reduced eGFR and presenting with
acute MI, with adjusted OR of 1.36 (95% CI, 0.99-1.86) for
eGFR 60 to 89 mL/min/1.73 m2, 1.55 (95% CI, 0.92-2.62) for eGFR 45
to 59 mL/min/1.73 m2, and 3.82 (95% CI, 1.55-9.46) for eGFR less
than 45 mL/min/1.73 m2. Self-reported hypertension was reported more
in patients with acute MI vs. angina. Patients with acute MI were also more
likely to be current or former cigarette smokers and to report minimal or light
prior physical leisure-time activity, but less likely to report parental or
sibling histories of
Chronic kidney disease (CKD) is a recognized risk factor for
cardiovascular disease, but it is not clear if the high mortality for CV
disease in CKD patients is due to the increased incidence of events or the
greater acuity of many of them. Symptoms alone can be unreliable since there is
an association between silent (asymptomatic) CAD and ESRD, so more objective
criteria are needed. Accordingly, in the present case control study, 803 adults
with CKD who had acute MIs as the initial manifestation of CAD were compared
with 419 patients with chronic stable angina. A "strong, independent, graded
risk was found between reduced estimated GFR and acute MI". Mechanisms that
promote plaque instability and inflammation in CKD may explain these findings.
Better means to identify the CKD population at risk should be a high priority
the authors suggest.
– Peter F. Cohn, MD
Editorial Board member
Disclosures: Dr. Cohn reports no relevant financial disclosures.