Received February 23, 2007
Accepted on August 13, 2007

ORIGINAL ARTICLES

Risk for Cardiovascular Outcomes among Subjects with Atherosclerotic Cardiovascular Disease and Greater-than-Normal Estimated Glomerular Filtration Rate

Jula K. Inrig ^*1, Barbara S. Gillespie , Uptal D. Patel ^*, Libbie P. Briley , Lilin She ^*, J. Donald Easton , Eric Topol ^||, and Lynda A. Szczech ^*

*Duke Clinical Research Institute, Duke University Medical Center, and Drug Safety Alliance, Inc., Durham, and Quintiles, Inc., Research Triangle Park, North Carolina; Department of Clinical Neurosciences, Brown Medical School/Rhode Island Hospital, Providence, Rhode Island; and ||Department of Medicine, Scripps Translational Science Institute, La Jolla, California

¹ To whom correspondence should be addressed. E-mail: inrig001{at}mc.duke.edu.

	Abstract

Background and objectives: Estimating equations for calculating glomerular filtration rate (eGFR) occasionally identify patients with elevated eGFR, yet the prognostic significance remains to be determined. This study sought to define the association of an elevated eGFR on the risk for death and cardiovascular outcomes among subjects with atherosclerotic cardiovascular disease.

Design, setting, participants, & measurements: Data from 8941 subjects who had a history of atherosclerotic vascular disease and were enrolled in the Blockade of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion trial were analyzed. Time to the composite end point of death, congestive heart failure, myocardial infarction, or stroke was modeled using Cox proportion hazards regression. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease and Cockcroft-Gault formulas.

Results: Compared with subjects with eGFR of 100 to 125 ml/min per 1.73 m², subjects with eGFR 125 (n = 462) were younger, female, and nonwhite. In addition, subjects with an elevated eGFR were more likely to have diabetes and congestive heart failure. In adjusted analyses, every 10-ml/min per 1.73 m² decrease in eGFR <100 was associated with a 13% increased hazard for the composite end point. In addition, every 10-ml/min per 1.73 m² increase in eGFR 100 was associated with a 9% increased hazard for the composite end point.

Conclusions: In individuals with a history of vascular disease, the relationship between eGFR and cardiovascular outcomes may be parabolic, with increased risk among patients with both reduced and elevated eGFR.