Association between Kidney Function and Framingham Global Cardiovascular Disease Risk Score: A Chinese Longitudinal Study

et al. (2014) Association between Kidney Function and Framingham Global Cardiovascular Disease Risk Score: A Chinese Longitudinal Study. PLoS ONE 9(1): e86082. doi:10.1371/journal.pone.0086082 Association between Kidney Function and Framingham Global Cardiovascular Disease Risk Score: A Chinese Longitudinal Study Bo Jin 0 Xiaojuan Bai 0 Lulu Han 0 Jing Liu 0 Weiguang Zhang 0 Xiangmei Chen 0 Cephas Tagumirwa Musabayane, University of KwaZulu-Natal, South Africa 0 1 Department of Gerontology and Geriatrics, Shengjing Hospital of China Medical University , Shenyang , China , 2 Department of Circulation, Asia Heart Hospital , Wuhan , China , 3 Department of Kidney, General Hospital of Chinese People's Liberation Army , Beijing , China Background: Chronic kidney disease (CKD) is generally considered an independent risk factor for cardiovascular disease (CVD) development, but rates in individuals with estimated glomerular filtration rate (eGFR) .60 ml/min/1.73 m2 are uncertain. The Framingham global CVD risk score (FRS) equation is a widely accepted tool used to predict CVD risk in the general population. The purpose of the present study was to examine whether an association exists between eGFR and FRS in a Chinese population with no CKD or CVD. Methods: A total of 333 participants were divided into three groups based on FRS. The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD-EPI equation for Asians (CKD-EPI-ASIA) were used to measure eGFR. Results: A significant inverse association between eGFR and FRS was confirmed with Pearson correlation coefficients of - 0.669, -0.698 (eGFRCKD-EPI, P,0.01) and -0.658, -0.690 (eGFRCKD-EPI-ASIA, P,0.01). This association gradually diminished with progression from the low- to high-risk groups (eGFRCKD-EPI, r = -0.615, -0.282, -0.197, P,0.01, P,0.01, P.0.05; similar results according to the CKD-EPI-ASIA equation). In the low- or moderate-risk new-groups, this association became stronger with increased FRS (eGFRCKD-EPI-ASIA, r = -0557, -0.622 or -0.326, -0.329, P,0.01). In contrast to the results from 2008, eGFR was independently associated with FRS following adjustment for traditional cardiovascular risk factors (P,0.05). Conclusion; Renal function has multiple influences on predicting CVD risk in various populations; With increasing FRS and 2 decreasing eGFR; it is also independently associated with CVD; even in individuals with eGFR; 60 ml/min/1; 73 m - Cardiovascular diseases (CVD), including coronary heart disease, stroke, peripheral artery disease and heart failure, constitute major public health issues worldwide [1]. Lifetime risk of CVD is substantial, and the condition is often silent or may occur without warning, underscoring the importance of prevention [2]. Efforts to estimate absolute CVD risk of individuals have devised numerous risk prediction tools that synthesize vascular risk factors, such as the Framingham global CVD risk score (FRS) equation. In addition to traditional cardiovascular risk factors, such as age, sex, high blood pressure, smoking, dyslipidemia and diabetes, investigators are trying to detect more markers associated with CVD, including those in which renal function is considered. Most nephrologists agree that estimated glomerular filtration rate (eGFR) is the most feasible clinical measure of renal function. Many studies have demonstrated that reduced eGFR is a predictor of major cardiovascular events [36]. However, the level of eGFR at which increased risk of CVD becomes apparent remains uncertain. Several studies have suggested that even small reductions in eGFR within the apparently normal range are associated with increased risk of CVD, while others suggest that the increase in risk may not become apparent until eGFR declines to ,60 ml/min/1.73 m2 [7]. The present study was performed in a Chinese community-based population with eGFR .60 ml/min/1.73 m2 and with no CVD to examine whether an association exists between eGFR and FRS. Materials and Methods 1. Study Participants This community-based longitudinal study was begun with the enrollment of subjects in a study that was approved by the Ethics Committee of China Medical University in Shenyang in 2008 with follow-up conducted in 2011. All study subjects signed informed consent forms. In 2008, 501 healthy subjects were confirmed to be study participants out of 1500 volunteers following examinations, which included measurements of fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), serum creatinine (Scr), blood urea nitrogen (BUN), and blood uric acid (UA). Electrocardiograms and chest X-rays were also performed. Following a three-year follow-up, 124 subjects were lost. As a result, 377 study subjects received the same examinations as were performed in 2008. Ultimately to enforce self-control, 333 subjects were confirmed as participants after excluding 34 subjects for data loss and 10 subjects with eGFR values ,60 ml/min/1.73 m2. 2. Data Collection Participants who self-reported that they smoked regularly during the previous 12 months prior to enrollment were classified as smokers [2], while the others were classified as non-smokers. Height, weight, waist circumference and hip circumference were measured at baseline, and body mass index (BMI), body surface area (BSA) and waist-to-hip ratio (WHR) were calculated. Blood pressure measurements were performed on the left arm of seated participants with a mercury-column sphygmomanometer and an appropriately sized cuff; an average of two physician-obtained measures constituted the examination of blood pressure. Hypertension was defined as a systolic blood pressure (SBP) $140 mmHg or diastolic blood pressure (DBP) $90 mmHg and/or taking antihypertensive medications. Diabetes was defined as fasting plasma glucose $126 mg/dl or the use of insulin or oral hypoglycemic medications. All biochemical indicators were tested using a Hitachi 747 automatic biochemistry analyzer following a 12 h fast. 3. Framingham Risk Score Criterion [2] and Grouping The Framingham global CVD risk score equation was used to calculate FRS according to cardiovascular risk factors of study participants. This equation includes six risk factors: age, systolic blood pressure, history of diabetes mellitus, cigarette smoking status, HDL-C and TC/LDL-C level [2]. Each risk factor of this equation has its corresponding Framingham score. The Framingham score for non-smokers was 0 points while that for male and female smokers was 4 points and 3 points, respectively; the score for participants with no diabetes history was 0 points; and the score for male and female diabetes mellitus patients was 3 points and 4 points, respectively. FRS is the sum of these six risk factor points. Participants were divided into three groups according to FRS [2]: low risk group: FRS #7 points in males and #9 points in fem (...truncated)