Accelerated coronary artery calcification in mildly reduced renal function of high-risk hypertensives: a 3-year prospective observation

Objective To examine the effect of mild renal dysfunction on coronary artery calcifications. Methods We examined the progression of coronary atherosclerosis, as measured by dual-section spiral computed tomography, using the total coronary artery calcium score as a quantitative measure of the burden of atherosclerosis. Of 547 high-risk Israeli hypertensive patients, who were participants of the prospective calcification study (a side-arm of the international INSIGHT study), 313 patients completed the 3-year follow-up. Subjects were studied upon entry (on placebo) and again after 3 years of treatment (nifedipine or thiazide). Patients were divided into two groups depending on their creatinine clearance: (i) less than or equal to 60 ml/min, renal dysfunction (RD) (n = 53) and (ii) > 60 ml/min, normal renal function group (n = 263). Results Blood pressure, hypercholesterolemia, and smoking did not differ between the groups. After 3 years of treatment, blood pressure control was similar, whereas the total coronary artery calcium score progression was twofold greater in the RD than the normal group (156 +/- 32 versus 64 +/- 8, respectively) (P= 0.006). In a multiple logistic regression analysis, the odds ratio (OR) for total coronary artery calcium score progression was higher for the RD group (2.1) [95% confidence interval (CI) 1.2-3.7]. Gender, body mass index, smoking, cholesterol, family history of ischaemic heart disease and diabetes were not significant predictors. Thiazide-based anti hypertensive therapy predicted a faster progression compared to nifedipine (OR 1.66, 95% CI 1.09-2.51). Conclusions Mild renal dysfunction accelerates coronary artery calcifications, above and beyond conventional risk factors. (C) 2003 Lippincott Williams Wilkins.