Renal function and long-term mortality in patients with asymptomatic carotid atherosclerosis

Matthias Hoke; Elisabeth Pernicka; Alexander Niessner; Georg Goliasch; Jasmin Amighi; Renate Koppensteiner; Erich Minar; Wolfgang Mlekusch; Helmut Rumpold; Oswald Wagner; Martin Schillinger

doi:10.1160/TH11-06-0383

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 107(01): 150-157
DOI: 10.1160/TH11-06-0383

Cardiovascular Biology and Cell Signalling

Schattauer GmbH

Renal function and long-term mortality in patients with asymptomatic carotid atherosclerosis

Authors

Matthias Hoke

¹Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
Elisabeth Pernicka

²Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
Alexander Niessner

³Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Georg Goliasch

³Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
Jasmin Amighi

¹Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
Renate Koppensteiner

¹Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
Erich Minar

¹Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
Wolfgang Mlekusch

¹Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
Helmut Rumpold

⁴Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
Oswald Wagner

⁴Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
Martin Schillinger

¹Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria

Abstract

Summary

Renal dysfunction is a risk factor for mortality in patients with atherosclerosis. Estimated glomerular filtration rate (eGFR), cystatin C (CysC) and beta-2-microglobulin (B2M) are measures of renal function. It remains unclear, which of these parameters is the strongest predictor of outcome in patients with atherosclerosis. All-cause and cardiovascular mortality were prospectively investigated in 1,065 consecutive patients with asymptomatic carotid atherosclerosis. During a median follow-up of 6.3 years 275 patients died (25.8%), including 182 (66.2%) from cardiovascular causes. Estimated GFR, CysC and B2M were all significantly and independently associated with mortality. Inclusion of the renal parameters CysC and B2M but not of eGFR into a model with established cardiovascular risk factors improved the C-statistics significantly (p=0.0035 and 0.036, respectively; p=0.182 for eGFR). The net reclassification improvement (NRI) was 32.4% (p<0.0001) for CysC, 29% (p<0.0001) for B2M, and 16.5% (p=0.019) for eGFR. The integrated discrimination improvement (IDI) was 0.014 (p=0.0009) for CysC and 0.011 (p=0.005) for B2M while it was not significant for eGFR. Results were consistent for various subgroups with different extent of atherosclerosis. In summary, CysC and B2M were found to be independent predictors for mortality and had superior predictive value compared to eGFR in patients with asymptomatic carotid atherosclerosis. The clinical importance of these findings has to be validated in larger studies with a community-based approach.

Keywords

Atherosclerosis - risk factors - cerebrovascular disease - clinical studies

Full Text

References

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