CKD predicts cardiac, cerebral events risk in patients with chronic coronary syndrome

Among patients with chronic coronary syndrome, those with chronic kidney disease (CKD) at baseline are at increased risk of major adverse cardiac and cerebral events (MACCE), according to data from the REAL‐CAD* study.

REAL‐CAD included 12,118 patients with chronic coronary syndrome who were randomly assigned to receive treatment with high‐dose (pitavastatin 4 mg/day) or low‐dose statin (pitavastatin 1 mg/day). The primary endpoint was MACCE, defined as a composite of cardiovascular death, nonfatal myocardial infarction, stroke, or unstable angina requiring hospitalization.

Of the patients, 4,340 had CKD at baseline and the remaining 7,778 did not. CKD was defined as having an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m². Patients who showed a decrease in eGFR of at least 20 percent in the initial year had worsening renal function, those with an annual decrease of greater than 0 percent but less than 20 percent had borderline renal function, and those with no decrease had stable renal function.

During the 5-year follow-up, MACCE occurred with significantly higher frequency in the CKD group than in the no-CKD group (9.5 percent vs 5.5 percent; p<0.0001).

Researchers conducted further analysis excluding 1,247 patients who had MACCE, were censored, or missing eGFR within 1 year. Of the 10,871 patients included, 3,885 had baseline CKD, 577 had worsening renal function, 6,014 had borderline renal function, and 4,280 maintained stable renal function.

Among patients with CKD, worsening renal function was independently associated with MACCE at 4 years as compared with stable renal function (hazard ratio [HR], 1.67, 95 percent confidence interval [CI], 1.03–2.73; p=0.039). For patients without CKD, borderline renal function emerged as a risk factor for MACCE at 4 years (HR, 1.40, 95 percent CI, 1.03–1.91; p=0.032).

The findings underscore the importance of aggressive lifestyle modification and optimal medical therapy even in patients without baseline CKD but a mild to moderate annual deterioration of renal function, the researchers said.

*Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy With Pitavastatin in Coronary Artery Disease