Research

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

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

This article has a correction

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

  1. Tobias Kurth, senior researcher1234,
  2. Paul E de Jong, professor5,
  3. Nancy R Cook, associate professor12,
  4. Julie E Buring, professor12678,
  5. Paul M Ridker, professor1256
  1. 1Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA
  2. 2Department of Epidemiology, Harvard School of Public Health, Boston MA
  3. 3INSERM Unit 708—Neuroepidemiology, Paris, France
  4. 4Faculty of Medicine, University Pierre et Marie Curie, Paris, France
  5. 5Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
  6. 6Center for Cardiovascular Disease Prevention, Department of Medicine, Brigham and Women’s Hospital
  7. 7Donald W Reynolds Center for Cardiovascular Research, Department of Medicine, Brigham and Women’s Hospital
  8. 8Department of Ambulatory Care and Prevention, Harvard Medical School
  1. 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
  • Accepted 13 February 2009

Abstract

Objective To evaluate the association of kidney function with cardiovascular disease and mortality among apparently healthy women.

Design Prospective cohort study.

Setting Women’s Health Study, United States.

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

Main outcome measures Time to cardiovascular disease (non-fatal stroke, non-fatal myocardial infarction, coronary revascularisation procedures, or death from cardiovascular cause), specific cardiovascular disease events, and all-cause mortality. End points were confirmed after review of medical records and death certificates.

Results Glomerular filtration rate (GFR) was estimated with the abbreviated Modification of Diet in Renal Disease Study equation. At baseline, 1315 (4.7%) women had GFR <60 ml/min/1.73 m2. During 12 years of follow-up, 1199 incident cardiovascular disease events and 856 deaths (179 from cardiovascular disease) occurred. Compared with women with GFR ≥90 ml/min/1.73 m2, the multivariable adjusted hazard ratios for any first cardiovascular disease 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 hazard ratios 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 findings were observed for myocardial infarction, stroke, coronary revascularisation, and non-cardiovascular death. However, an increased risk of death from cardiovascular disease was found among women with GFR <60 ml/min/1.73 m2 (hazard ratio 1.68 (1.02 to 2.79)).

Conclusions In this large cohort of women, a glomerular filtration rate <60 ml/min/1.73 m2 was associated with increased risk of cardiovascular disease death but not other cardiovascular disease events or non-cardiovascular disease mortality. We observed no increase in risk of any of the outcomes among women with less severe impairment of kidney function.

Footnotes

  • We thank the participants in the Women’s Health Study for their outstanding commitment and cooperation, the Women’s Health Study staff for their expert and unfailing assistance, and Eunjung Kim for programming assistance.

  • Contributions: TK conceived and designed the study, analysed the data, and drafted the manuscript. JEB and PMR were responsible for data acquisition. All authors interpreted the data, critically revised the draft, and gave final approval of the version to be published. TK is guarantor of the study.

  • Funding: The Women’s Health Study is supported by grants and from the National Heart, Lung, and Blood Institute (HL-043851 and HL-080467), and the National Cancer Institute (CA-047988). The research for this work was supported by grants from the Donald W Reynolds Foundation, the Leducq Foundation, and the Doris Duke Charitable Foundation.

  • The funding sources played no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the manuscript; or in the decision to submit the manuscript for publication.

  • Competing interests: None declared, but we report a full disclosure for the past five years. TK has received research funding from Merck, McNeil Consumer & Specialty Pharmaceuticals, the National Institutes of Health, and Wyeth Consumer Healthcare; is a consultant to i3 Drug Safety and World Health Information Science Consultants, LLC; and received honorariums from Genzyme, Merck, and Pfizer for lectures. PEdJ has received research funding from the Dutch Kidney Foundation. NRC has received research funding and support from the National Institutes of Health and from Roche Molecular Systems. JEB has received research funding and support from Dow Corning Corporation and the National Institutes of Health; research support from Bayer Heath Care and the Natural Source Vitamin E Association; honorariums from Bayer for lectures; and serves on an external scientific advisory committee for a study by Procter & Gamble. PMR has received research funding and support from the American Heart Association, AstraZeneca, Bayer, Bristol-Myers Squibb, Dade-Behring, Doris Duke Charitable Foundation, James and Polly Annenberg La Vea Charitable Trusts, Leducq Foundation, the National Institutes of Health, Novartis, Merck, Donald W Reynolds Foundation, Pharmacia, Roche, Sanofi/Aventis, and Variagenics; is listed as coinventor on patents held by Brigham and Women’s Hospital on the use of inflammatory biomarkers in cardiovascular disease; and has served as consultant to AstraZeneca, Dade-Behring, Interleukin Genetics, Isis Pharmaceuticals, Sanofi/Aventis, and Schering-Plough,

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.

Rapid responses

THIS WEEK'S POLL

Read related article

See previous polls

BMJ most popular