Abstract
Based on global cardiovascular (CV) risk assessment for example using the Framingham risk score, it is recommended that those with high risk should be treated and those with low risk should not be treated. The recommendation for those of medium risk is less clear and uncertain. We aimed to determine whether factoring in chronic kidney disease (CKD) will improve CV risk prediction in those with medium risk. This is a 10-year retrospective cohort study of 905 subjects in a primary care clinic setting. Baseline CV risk profile and serum creatinine in 1998 were captured from patients record. Framingham general cardiovascular disease risk score (FRS) for each patient was computed. All cardiovascular disease (CVD) events from 1998–2007 were captured. Overall, patients with CKD had higher FRS risk score (25.9% vs 20%, p = 0.001) and more CVD events (22.3% vs 11.9%, p = 0.002) over a 10-year period compared to patients without CKD. In patients with medium CV risk, there was no significant difference in the FRS score among those with and without CKD (14.4% vs 14.6%, p = 0.84) However, in this same medium risk group, patients with CKD had more CV events compared to those without CKD (26.7% vs 6.6%, p = 0.005). This is in contrast to patients in the low and high risk group where there was no difference in CVD events whether these patients had or did not have CKD. There were more CV events in the Framingham medium risk group when they also had CKD compared those in the same risk group without CKD. Hence factoring in CKD for those with medium risk helps to further stratify and identify those who are actually at greater risk, when treatment may be more likely to be indicated.
Highlights
Our study showed that overall, patients with chronic kidney diease (CKD) have higher predicted cardiovascular disease (CVD) risk and more CVD events compared to those without CKD
This is consistent with studies which showed that CKD is associated with higher CVD morbidity and mortality.[10, 19,20,21]
In India, studies have shown that CKD was associated with higher CVD risk score and CVD events. [1, 24] This same relationship of CKD and CVD risk have been shown among Caucasians population as well. [6, 10, 25] Our study showed that Indians have higher CVD events compared to the other races regardless of the CKD status and this is consistent with a study done in Canada where South Asians like those from India have higher prevalence of CVD compared to Chinese and Caucasians.[26]
Summary
The prevalence of chronic kidney diease (CKD) is increasing in Asian countries and is even higher than the developed western countries. [1,2,3,4] CKD is associated with atherosclerosisPLOS ONE | DOI:10.1371/journal.pone.0141344 October 23, 2015Chronic Kidney Disease and Cardiovascular Risk Prediction in coronary, cerebral and peripheral arterial circulation and is an independent risk factor for cardiovascular disease (CVD). [5,6,7,8,9] Patients with CKD developed significant CVD morbidity and mortality before they even reach end-stage renal disease (ESRD). [10]Cardiovascular (CV) risk stratification is important in identifiying those with high global CV risk so that primary prevention and treatment can be initiated early to reduce CV events. [11] Several CV risk prediction models have been developed to estimate risk, among them is the Framingham risk score (FRS). Chronic Kidney Disease and Cardiovascular Risk Prediction in coronary, cerebral and peripheral arterial circulation and is an independent risk factor for cardiovascular disease (CVD). [11] Several CV risk prediction models have been developed to estimate risk, among them is the Framingham risk score (FRS). [12,13,14] Based on this risk stratification model, it is recommended that those with high risk be treated and those with low risk should not be given any treatment. The recommendation for those medium risk is less clear and uncertain. We aimed to assess whether the presence or absence of CKD will improve the prediction in those with medium risk
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