Tian Ling, Jaeger Byron C, Scialla Julia J, Budoff Matthew J, Mehta Rupal C, Jaar Bernard G, Saab Georges, Dobre Mirela A, Reilly Muredach P, Rader Daniel J, Townsend Raymond R, Lash James P, Greenland Philip, Isakova Tamara, Bundy Joshua D
Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Translational Science Institute, Tulane University, New Orleans, Louisiana.
Biostatistics and Data Science, Division of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Am J Kidney Dis. 2025 Jan;85(1):67-77.e1. doi: 10.1053/j.ajkd.2024.06.018. Epub 2024 Aug 16.
RATIONALE & OBJECTIVE: Coronary artery calcification (CAC) progresses rapidly in people with chronic kidney disease (CKD) compared with the general population. We studied the association between CAC progression and higher risks of atherosclerotic cardiovascular disease (CVD), congestive heart failure, and all-cause mortality among adults with CKD.
Prospective cohort study.
SETTING & PARTICIPANTS: 1,310 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study who had at least 1 CAC scan with no prior history of CVD and with observed or imputed data on changes in CAC over time.
Observed or imputed CAC progression, categorized as incident CAC among participants with 0 CAC on the baseline scan or progressive CAC when the baseline scan demonstrated CAC and there was an increase in CAC≥50 Agatston units per year.
Atherosclerotic CVD (myocardial infarction or stroke), congestive heart failure, and all-cause mortality.
Cause-specific Cox proportional hazards regression, stratified by presence of CAC at baseline.
A total of 545 participants without and 765 with prevalent CAC at baseline were included. During a mean 3.3 years between CAC assessments, 177 participants (32.5%) without baseline CAC developed incident CAC while 270 participants (35.3%) with baseline CAC developed a≥50 Agatston units per year increase in CAC. After multivariable adjustment, incident CAC was associated with 2.42-fold higher rate of atherosclerotic CVD (95% CI, 1.23-4.79) and 1.82-fold higher rate of all-cause mortality (95% CI, 1.03-3.22). Progressive CAC (≥50 units per year) was not associated with atherosclerotic CVD (HR, 1.42 [95% CI, 0.85-2.35]) but was associated with a 1.73-fold higher rate of all-cause mortality (95% CI, 1.31-2.28). Progressive CAC was not associated with incident heart failure.
Residual confounding and limited statistical power for some outcomes.
Among adults with CKD stages 2-4, CAC progression over a mean 3.3 years was associated with higher risk of atherosclerotic CVD and all-cause mortality. The associations were strongest among participants without CAC at baseline.
PLAIN-LANGUAGE SUMMARY: Prior research has shown that coronary artery calcification (CAC) is a marker of higher risk of heart disease and death. Less is known about how changes in CAC over time might affect risk, particularly among patients with kidney disease. In this study, participants with chronic kidney disease who developed CAC or had worsening CAC over time showed higher rates of heart attack, stroke, and death than those who did not develop CAC. These findings support the need for further research on longitudinal changes in CAC as a possible aid to establishing prognosis among patients with kidney disease and to inform treatment.
与普通人群相比，慢性肾脏病（CKD）患者的冠状动脉钙化（CAC）进展迅速。我们研究了CKD成人患者中CAC进展与动脉粥样硬化性心血管疾病（CVD）、充血性心力衰竭及全因死亡率较高风险之间的关联。
前瞻性队列研究。
慢性肾功能不全队列（CRIC）研究中的1310名参与者，他们至少进行过1次CAC扫描，无CVD病史，且有关于CAC随时间变化的观察或推算数据。
观察到的或推算的CAC进展，在基线扫描时CAC为0的参与者中分类为新发CAC，基线扫描显示有CAC且每年CAC增加≥50阿加斯顿单位时分类为进展性CAC。
动脉粥样硬化性CVD（心肌梗死或中风）、充血性心力衰竭及全因死亡率。
特定病因的Cox比例风险回归，按基线时是否存在CAC分层。
共纳入545名基线时无CAC和765名有CAC的参与者。在两次CAC评估之间的平均3.3年期间，177名（32.5%）基线无CAC的参与者出现新发CAC，而270名（35.3%）基线有CAC的参与者CAC每年增加≥50阿加斯顿单位。多变量调整后，新发CAC与动脉粥样硬化性CVD发生率高2.42倍相关（95%CI，1.23 - 4.79），与全因死亡率高1.82倍相关（95%CI，1.03 - 3.22）。进展性CAC（每年≥50单位）与动脉粥样硬化性CVD无关（HR，1.42[95%CI，0.85 - 2.35]），但与全因死亡率高1.73倍相关（95%CI，1.31 - 2.28）。进展性CAC与新发心力衰竭无关。
存在残余混杂因素，且某些结局的统计效力有限。
在2 - 4期CKD成人患者中，平均3.3年的CAC进展与动脉粥样硬化性CVD和全因死亡率较高风险相关。这些关联在基线无CAC的参与者中最为明显。
先前的研究表明，冠状动脉钙化（CAC）是心脏病和死亡风险较高的标志物。关于CAC随时间的变化如何影响风险，尤其是在肾病患者中，人们了解较少。在本研究中，随着时间推移出现CAC或CAC恶化的慢性肾病参与者，其心脏病发作、中风和死亡的发生率高于未出现CAC的参与者。这些发现支持进一步研究CAC的纵向变化，以帮助确定肾病患者的预后并为治疗提供信息。
