Studies suggest that impaired kidney function is associated with cardiovascular disease (CVD) and mortality, particularly CVD death, among patients with existing kidney disease or CVD. Data in primary prevention are sparse. We aimed to evaluate the association of kidney function with CVD and mortality among apparently healthy women.
Prospective cohort study among 27,939 female health professionals aged ≥45 who were free of CVD and provided a blood sample at study entry.
Women's health study, United States.
Main outcome measures
Time to CVD (nonfatal stroke, nonfatal myocardial infarction, coronary revascularization procedures, or death from cardiovascular cause), specific CVD events, and all-cause mortality. Endpoints were confirmed after medical record and death certificate review.
We estimated glomerular filtration rate (GFR) using the abbreviated Modification-of-Diet-in-Renal-Disease-Study equation. At baseline, 1,315 (4.7%) women had GFR <60 ml/min/1.73m2. During 12 years of follow-up, 1,199 incident CVD events and 856 deaths (179 from CVD) occurred. Compared with women with GFR ≥90 ml/min/1.73m2, the multivariable-adjusted hazard ratios (HRs) (95% confidence intervals) were 0.95 (0.83−1.08), 0.84 (0.70−1.00), and 1.00 (0.79−1.27) for any first CVD and 0.93 (0.79−1.09), 1.03 (0.85−1.26), and 1.09 (0.83−1.45) for all-cause mortality among women with GFR levels of 75−89.9, 60−74.9, and <60 ml/min/1.73 m2, respectively. Similar null findings were observed for myocardial infarction, stroke, coronary revascularization, and non-cardiovascular death. In contrast, we observed an increased risk of CVD death (HR=1.68; 1.02−2.79) for women with GFR <60 ml/min/1.73m2.
In this large cohort of women, GFR <60 ml/min/1.73m2 appeared to be associated with increased risk of CVD death but not other CVD events or non-CVD mortality. We observed no increase in risk of any of the outcomes among women with less severe impairment of kidney function.