Renal function and risk of coronary heart disease in general populations: New prospective study and systematic review

Background End-stage chronic kidney disease is associated with striking excesses of cardiovascular mortality, but it is uncertain to what extent renal function is related to risk of subsequent coronary heart disease ( CHD) in apparently healthy adults. This study aims to quantify the association of markers of renal function with CHD risk in essentially general populations. Methods and Findings Estimated glomerular filtration rate ( eGFR) was calculated using standard prediction equations based on serum creatinine measurements made in 2,007 patients diagnosed with nonfatal myocardial infarction or coronary death during follow-up and in 3,869 people without CHD in the Reykjavik population-based cohort of 18,569 individuals. There were small and nonsignificant odds ratios ( ORs) for CHD risk over most of the range in eGFR, except in the lowest category of the lowest fifth ( corresponding to values of,60 ml/min/1.73m(2)), in which the OR was 1.33 ( 95% confidence interval 1.01-1.75) after adjustment for several established cardiovascular risk factors. Findings from the Reykjavik study were reinforced by a meta-analysis of six previous reports ( identified in electronic and other databases) involving a total of 4,720 incident CHD cases ( including Reykjavik), which yielded a combined risk ratio of 1.41 ( 95% confidence interval 1.19-1.68) in individuals with baseline eGFR less than 60 ml/min/1.73m(2) compared with those with higher values. Conclusions Although there are no strong associations between lower-than-average eGFR and CHD risk in apparently healthy adults over most of the range in renal function, there may be a moderate increase in CHD risk associated with very low eGFR ( i.e., renal dysfunction) in the general population. These findings could have implications for the further understanding of CHD and targeting cardioprotective interventions.