Dataset Information

Coronary Artery Calcification Score as A Predictor of All-Cause Mortality and Cardiovascular Outcome in Peritoneal Dialysis Patients.

ABSTRACT:

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Background

This study aimed to examine whether the coronary artery calcification score (CaCS) was associated with the prognosis of peritoneal dialysis (PD) patients. ?

Methods

Adult PD patients who were clinically stable for at least 2 months were recruited for this prospective, observational cohort study. Coronary artery calcification was assessed using multislice spiral computed tomography and was recorded according to the Agatston score. The endpoints including all-cause mortality, cardiovascular events, and cardiovascular mortality were assessed. Multivariate Cox regression was used to identify independent predictors of all-cause mortality, cardiovascular events (CVEs), and cardiovascular mortality. ?

Results

A total of 179 PD patients (86 men) with a mean age of 63.5 ± 14.8 years were recruited for this study. Coronary artery calcification scores ranging from 0 to 5,257 were stratified as follows: no (CaCS = 0, n = 54), low (0 < CaCS < 400, n = 72), and high (CaCS ? 400, n = 53) calcification. The follow-up duration was 30.6 ± 16.2 (24-63) months. Compared with the no calcification group, patients with a higher CaCS were older and had lower diastolic blood pressure, residual renal function, and serum albumin, and higher HbA1C and serum insulin. Multivariate Cox regression revealed that the CaCS was an independent predictor for all the 3 endpoints after adjustment in PD patients. ?

Conclusions

CaCS was an independent predictor of all-cause mortality, cardiovascular events, and cardiovascular mortality in patients receiving peritoneal dialysis.

SUBMITTER: Xie Q

PROVIDER: S-EPMC4803361 | biostudies-literature | 2016 Mar-Apr

REPOSITORIES: biostudies-literature

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Publications

Coronary Artery Calcification Score as A Predictor of All-Cause Mortality and Cardiovascular Outcome in Peritoneal Dialysis Patients.

Xie Qionghong Q Ge Xiaolin X Shang Da D Li Yun Y Yan Huanqing H Tian Jing J Hao Chuan-Ming CM Zhu Tongying T

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 20150729 2

<h4>Unlabelled</h4>♦<h4>Background</h4>This study aimed to examine whether the coronary artery calcification score (CaCS) was associated with the prognosis of peritoneal dialysis (PD) patients. ♦<h4>Methods</h4>Adult PD patients who were clinically stable for at least 2 months were recruited for this prospective, observational cohort study. Coronary artery calcification was assessed using multislice spiral computed tomography and was recorded according to the Agatston score. The endpoints includ ...[more]

PMID: 26224787

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Project description:BACKGROUND:Vascular calcification is seen in most patients on dialysis and is strongly associated with cardiovascular mortality. Vascular calcification is promoted by phosphate, which generally reaches higher levels in hemodialysis than in peritoneal dialysis. However, whether vascular calcification develops less in peritoneal dialysis than in hemodialysis is currently unknown. Therefore, we compared coronary artery calcification (CAC), its progression, and calcification biomarkers between patients on hemodialysis and peritoneal dialysis. METHODS:We measured CAC in 134 patients who had been treated exclusively with hemodialysis (n = 94) or peritoneal dialysis (n = 40) and were transplantation candidates. In 57 of them (34 on hemodialysis and 23 on peritoneal dialysis), we also measured CAC progression annually up to 3 years and the inactive species of desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), fetuin-A, osteoprotegerin. We compared CAC cross-sectionally with Tobit regression. CAC progression was compared in 2 ways: with linear mixed models as the difference in square root transformed volume score per year (?CAC SQRV) and with Tobit mixed models. We adjusted for potential confounders. RESULTS:In the cross-sectional cohort, CAC volume scores were 92 mm3 in hemodialysis and 492 mm3 in peritoneal dialysis (adjusted difference 436 mm3; 95% CI -47 to 919; p = 0.08). In the longitudinal cohort, peritoneal dialysis was associated with significantly more CAC progression defined as ?CAC SQRV (adjusted difference 1.20; 95% CI 0.09 to 2.31; p = 0.03), but not with Tobit mixed models (adjusted difference in CAC score increase per year 106 mm3; 95% CI -140 to 352; p = 0.40). Peritoneal dialysis was associated with higher osteoprotegerin (adjusted p = 0.02) but not with dp-ucMGP or fetuin-A. CONCLUSIONS:Peritoneal dialysis is not associated with less CAC or CAC progression than hemodialysis, and perhaps with even more progression. This indicates that vascular calcification does not develop less in peritoneal dialysis than in hemodialysis.

Project description:The 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for cholesterol management defined new eligibility criteria for statin therapy. However, it is unclear whether this approach improves identification of adults at higher risk of cardiovascular events.To determine whether the ACC/AHA guidelines improve identification of individuals who develop incident cardiovascular disease (CVD) and/or have coronary artery calcification (CAC) compared with the National Cholesterol Education Program's 2004 Updated Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines.Longitudinal community-based cohort study, with participants for this investigation drawn from the offspring and third-generation cohorts of the Framingham Heart Study. Participants underwent multidetector computed tomography for CAC between 2002 and 2005 and were followed up for a median of 9.4 years for incident CVD.Statin eligibility was determined based on Framingham risk factors and low-density lipoprotein thresholds for ATP III, whereas the pooled cohort calculator was used for ACC/AHA.The primary outcome was incident CVD (myocardial infarction, death due to coronary heart disease [CHD], or ischemic stroke). Secondary outcomes were CHD and CAC (as measured by the Agatston score).Among 2435 statin-naive participants (mean age, 51.3 [SD, 8.6] years; 56% female), 39% (941/2435) were statin eligible by ACC/AHA compared with 14% (348/2435) by ATP III (P?<?.001). There were 74 incident CVD events (40 nonfatal myocardial infarctions, 31 nonfatal ischemic strokes, and 3 fatal CHD events). Participants who were statin eligible by ACC/AHA had increased hazard ratios for incident CVD compared with those eligible by ATP III: 6.8 (95% CI, 3.8-11.9) vs 3.1 (95% CI, 1.9-5.0), respectively (P<.001). Similar results were seen for CVD in participants with intermediate Framingham Risk Scores and for CHD. Participants who were newly statin eligible (n?=?593 [24%]) had an incident CVD rate of 5.7%, yielding a number needed to treat of 39 to 58. Participants with CAC were more likely to be statin eligible by ACC/AHA than by ATP III: CAC score >0 (n?=?1015): 63% vs 23%; CAC score >100 (n?=?376): 80% vs 32%; and CAC score >300 (n?=?186): 85% vs 34% (all P?<?.001). A CAC score of 0 identified a low-risk group among ACC/AHA statin-eligible participants (306/941 [33%]) with a CVD rate of 1.6%.In this community-based primary prevention cohort, the ACC/AHA guidelines for determining statin eligibility, compared with the ATP III, were associated with greater accuracy and efficiency in identifying increased risk of incident CVD and subclinical coronary artery disease, particularly in intermediate-risk participants.

Project description:Importance:Few data are available to guide clinical recommendations for individuals with high levels of physical activity in the presence of clinically significant coronary artery calcification (CAC). Objective:To assess the association among high levels of physical activity, prevalent CAC, and subsequent mortality risk. Design, Setting, and Participants:The Cooper Center Longitudinal Study is a prospective observational study of patients from the Cooper Clinic, a preventive medicine facility. The present study included participants seen from January 13, 1998, through December 30, 2013, with mortality follow-up through December 31, 2014. A total of 21 758 generally healthy men without prevalent cardiovascular disease (CVD) were included if they reported their physical activity level and underwent CAC scanning. Data were analyzed from September 26, 2017, through May 2, 2018. Exposures:Self-reported physical activity was categorized into at least 3000 (n = 1561), 1500 to 2999 (n = 3750), and less than 1500 (n = 16 447) metabolic equivalent of task (MET)-minutes/week (min/wk). The CAC scores were categorized into at least 100 (n = 5314) and less than 100 (n = 16 444) Agatston units (AU). Main Outcomes and Measures:All-cause and CVD mortality collected from the National Death Index Plus. Results:Among the 21 758 male participants, baseline mean (SD) age was 51.7 (8.4) years. Men with at least 3000 MET-min/wk were more likely to have prevalent CAC of at least 100 AU (relative risk, 1.11; 95% CI, 1.03-1.20) compared with those accumulating less physical activity. In the group with physical activity of at least 3000 MET-min/wk and CAC of at least 100 AU, mean (SD) CAC level was 807 (1120) AU. After a mean (SD) follow-up of 10.4 (4.3) years, 759 all-cause and 180 CVD deaths occurred, including 40 all-cause and 10 CVD deaths among those with physical activity of at least 3000 MET-min/wk. Men with CAC of less than 100 AU and physical activity of at least 3000 MET-min/wk were about half as likely to die compared with men with less than 1500 MET-min/wk (hazard ratio [HR], 0.52; 95% CI, 0.29-0.91). In the group with CAC of at least 100 AU, men with at least 3000 MET-min/wk did not have a significant increase in all-cause mortality (HR, 0.77; 95% CI, 0.52-1.15) when compared with men with physical activity of less than 1500 MET-min/wk. In the least active men, those with CAC of at least 100 AU were twice as likely to die of CVD compared with those with CAC of less than 100 AU (HR, 1.93; 95% CI, 1.34-2.78). Conclusions and Relevance:This study suggests there is evidence that high levels of physical activity (≥3000 MET-min/wk) are associated with prevalent CAC but are not associated with increased all-cause or CVD mortality after a decade of follow-up, even in the presence of clinically significant CAC levels.

Dataset Information

Coronary Artery Calcification Score as A Predictor of All-Cause Mortality and Cardiovascular Outcome in Peritoneal Dialysis Patients.

Unlabelled

Background

Methods

Results

Conclusions

Publications

Coronary Artery Calcification Score as A Predictor of All-Cause Mortality and Cardiovascular Outcome in Peritoneal Dialysis Patients.

Similar Datasets

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