Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study

doi:10.1136/bmj.b2392

Published 29 June 2009, doi:10.1136/bmj.b2392
Cite this as: BMJ 2009;338:b2392

Research

Kidney function and risk of cardiovascular disease and mortality in women: a prospective cohort study

Tobias Kurth, senior researcher¹^,2^,3^,4, Paul E de Jong, professor⁵, Nancy R Cook, associate professor¹^,2, Julie E Buring, professor¹^,2^,6^,7^,8, Paul M Ridker, professor¹^,2^,5^,6

¹ Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA, ² Department of Epidemiology, Harvard School of Public Health, Boston MA, ³ INSERM Unit 708—Neuroepidemiology, Paris, France, ⁴ Faculty of Medicine, University Pierre et Marie Curie, Paris, France, ⁵ Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands, ⁶ Center for Cardiovascular Disease Prevention, Department of Medicine, Brigham and Women’s Hospital, ⁷ Donald W Reynolds Center for Cardiovascular Research, Department of Medicine, Brigham and Women’s Hospital, ⁸ Department of Ambulatory Care and Prevention, Harvard Medical School

Correspondence to: T Kurth, INSERM Unit 708—Neuroepidemiology, Hôpital de la Pitié-Salpêtrière, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France tkurth{at}rics.bwh.harvard.edu

Objective To evaluate the association of kidney function withcardiovascular disease and mortality among apparently healthywomen.

Design Prospective cohort study.

Setting Women’s Health Study, United States.

Participants 27 939 female health professionals aged $≥$ 45 whowere free of cardiovascular disease and other major diseaseand who provided a blood sample at study entry.

Main outcome measures Time to cardiovascular disease (non-fatalstroke, non-fatal myocardial infarction, coronary revascularisationprocedures, or death from cardiovascular cause), specific cardiovasculardisease events, and all-cause mortality. End points were confirmedafter review of medical records and death certificates.

Results Glomerular filtration rate (GFR) was estimated withthe abbreviated Modification of Diet in Renal Disease Studyequation. At baseline, 1315 (4.7%) women had GFR <60 ml/min/1.73m². During 12 years of follow-up, 1199 incident cardiovasculardisease events and 856 deaths (179 from cardiovascular disease)occurred. Compared with women with GFR $≥$ 90 ml/min/1.73 m², themultivariable adjusted hazard ratios for any first cardiovasculardisease were 0.95 (95% CI 0.83 to 1.08), 0.84 (0.70 to 1.00),and 1.00 (0.79 to 1.27) among women with GFR of 75-89.9, 60-74.9,and <60 ml/min/1.73 m², respectively; the equivalent hazardratios for all cause mortality were 0.93 (0.79 to 1.09), 1.03(0.85 to 1.26), and 1.09 (0.83 to 1.45). Similar null findingswere observed for myocardial infarction, stroke, coronary revascularisation,and non-cardiovascular death. However, an increased risk ofdeath from cardiovascular disease was found among women withGFR <60 ml/min/1.73 m² (hazard ratio 1.68 (1.02 to 2.79)).

Conclusions In this large cohort of women, a glomerular filtrationrate <60 ml/min/1.73 m² was associated with increased riskof cardiovascular disease death but not other cardiovasculardisease events or non-cardiovascular disease mortality. We observedno increase in risk of any of the outcomes among women withless severe impairment of kidney function.

© Kurth et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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