Modification Effect of Changes in Cardiometabolic Traits in the Association between History of Kidney Stones and Cardiovascular Diseases Events

Abstract

Background: We investigated the modification effect of status changes in metabolic syndrome (MetS) on the association of a kidney stones history with risk of major CVD events. Methods: We performed a prospective association and interaction study in a nationwide cohort including 129172 participants aged ≥ 40 years without CVDs at baseline and followed up for an average of 3·8 years. Kidney stones information was collected by using a questionnaire and validated by medical records. The repeated biochemical measurements were performed to ascertain the metabolic status at both baseline and follow-up. Findings: The presence rate of kidney stones was 4·28% in 44,958 men and 2·68% in 84,214 women. 4,017 incident total CVDs were documented and ascertained. Kidney stones were significantly associated with 44%, 70% and 31% higher risk of CVDs, coronary heart disease and stroke, respectively, after adjustments for traditional risk factors of CVDs. Interestingly, stratified analysis showed that significant associations were found in the incident and the sustained MetS patients, while no significant associations were found in the non-MetS at both baseline and follow-up or the MetS remission ones. For change status of each single component of the MetS, though the trends were not always the same, the associations were consistently significant in those with sustained metabolic disorders. Interpretation: A kidney stones history in women with newly developed or long-standing MetS associate with an increased risk of CVD. The mechanisms link kidney stones and CVD risk in the metabolic and non-metabolic pathways were warranted for further studies. Funding: This work was funded by the National Key R&D Program of China (2018YFC1311705, 2016YFC1305600, 2016YFC1305202, 2016YFC1304904, 2017YFC1310700 and 2018YFC1311800), the National Natural Science Foundation of China (81941017, 81970706, 81970728, 81870560, 81730023 and 81770842), the National Major Scientific and Technological Special Project for “Significant New Drugs Development” (2017ZX09304007), the Shanghai Science and Technology Commission (YDZX2017310000488) and the Clinical Research Plan of SHDC (SHDC2020CR1001A and SHDC2020CR3069B), and the Shanghai Municipal Education Commission–Gaofeng Clinical Medicine Grant Support (20152508 Round 2). M. X., J. L., M. L., T.W., Y. X., Z. Z., Y. B., W. W., and G. N. are members of innovative research team of high-level local universities in Shanghai. Declaration of Interest: We declare no competing interests. Ethical Approval: The study was approved by the Medical Ethics Committee of Ruijin Hospital, Shanghai Jiao-Tong University School of Medicine.