Chronic Kidney Disease associated with Increased Mortality in Patients with Coronary Artery Disease - Silent MI.

Editor's note: Patient with chronic kidney disease (CKD) frequently also have heart disease or coronary artery disease. The study presented below highlights the decreased length of survival among patients diagnosed with a silent mycoradial infarction who also have chronic kidney disease.

SILENT MYOCARDIAL ISCHEMIA AND CHRONIC KIDNEY DISEASE: THE FATAL DANCE
Ammar Almehmi*,et al

Presented at National Kidney Foundation Meeting April 2010

The objective of this study was to determine the relationship between
silent myocardial ischemia, glomerular filtration rate (GFR) and
mortality in patients with coronary artery disease (CAD) patients.

This study enrolled 346 patients who had undergone percutaneous
coronary intervention (PCI). Silent myocardial ischemia (SMI) was
defined as the absence of chest pain in response to balloon dilatation of
the affected vessel during PCI.

GFR was estimated using the MDRD formula.
Patients were categorized as having normal renal function
(GFR ≥90 ml/min), mild renal dysfunction (GFR 60 to 89 ml/min),
moderate dysfunction (GFR 30 to 59 ml/ min), and severe dysfunction
(GFR ≤ 29 ml/min).

This study included 64.2 % men, 31.2 % current smokers, and 35.3 %
diabetics, with mean age 64.5 ± 12 yr (mean ± SD), LDL cholesterol
101 ± 34 mg/dL, blood pressure 141 ± 26 / 76 ± 14 mmHg, and serum
creatinine 1.14 ± 0.85 mg/dL.

Cumulative 10-yr survival rates decreased in a graded fashion
from 80% for those with normal renal function to 25% for those with GFR ≤ 29 ml/min.
Compared with patients with normal renal function, the multivariable adjusted hazard
ratios for all-cause mortality among patients with mild, moderate, and
severe renal impairment were 1.11 (95% confidence interval [CI],
0.60–2.07), 1.75 (95% CI, 0.94–3.28), and 2.79 (95% CI, 1.16–6.77),
respectively. Furthermore, patients with both GFR ≤ 60 ml/min and
SMI had a worse survival compared to those with GFR > 60 and had no SMI.

Renal function is a graded and independent predictor of long-term
mortality in patients with CAD. SMI is associated with poor survival
in patients with compromised GFR.

These findings may underlie the increased sudden cardiac death in patients with renal dysfunction.

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Author Interview: Claes Held MD Associate professor at Uppsala Clinical Research Center and the Cardiology department at Uppsala University Hospital in Sweden Publication: Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study Eur Heart J first published online January 11, 2012 doi:10.1093/eurheartj/ehr432 2012 doi:10.1093/eurheartj/ehr432 Claes Held, Romaina Iqbal, Scott A. Lear, Annika Rosengren, Shofiqul Islam,James Mathew, and Salim Yusuf What are the main findings of the study? The main findings are he following: It is well known that physical inactivity is a risk factor for developing cardiovascular disease. Our study shows that being physically active reduces the risk of having a heart attack. Older studies have mostly studied people in the developed countries. This study which has a global perspective and includes 52 countries from all continents, shows that physical inactivity reduces the risk also in both low- middle-and high-income countries. We also found that ownership of a car and TV was associated with a more than doubled risk of being sedentary and that in low- and middle income the risk for a heart attack was increased with 27 %. We can however, not conclude from this study that there is a causal relationship but it is an interesting finding.     Were any of the findings unexpected? We looked at the relationship between physical activity both at work and during leisure time. A bit surprising was that people with heavy physical labor did not have a reduction in the risk of heart attacks, whereas people with both mild and moderate intensity did. What should clinicians and patients take away from this study? The main findings above and also that physical activity with duration below the recommended 30 minutes/day does seem to prevent from heart attacks as well although not as much as when you do it according to guidelines. This may be a comfort to those who are completely sedentary and feel that it would be a too big step to move to the 30 minutes/day right away. All PA does a good job for the heart as compared to not doing anything at all!   What recommendations do you have for cardiology health care providers as a result of your study? It would be interesting to follow up on the ownership of car and TV and do a prospective study to see if the theory holds true. More Author Interview from Angina.com More on Exercise and Heart Disease More on Heart Attack Studies   3M Littmann Master Classic II Stethoscope

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