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Kidney Week

Abstract: TH-PO447

Hypertension (HTN) Modifies the Association of Coronary Artery Calcification (CAC) with CV Events in CKD and Non-CKD Individuals

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular


  • Gregg, Lucile Parker, UT Southwestern , Dallas, Texas, United States
  • Adams-Huet, Beverley, UT Southwestern , Dallas, Texas, United States
  • Li, Xilong, UT Southwestern , Dallas, Texas, United States
  • Delemos, James, UT Southwestern , Dallas, Texas, United States
  • Hedayati, Susan, UT Southwestern , Dallas, Texas, United States

Few studies examine whether HTN and CKD modify the association of CAC with CV events. We evaluated these associations at various CAC cutoffs with fatal or nonfatal CV events.


We studied 2,288 asymptomatic participants of the Dallas Heart Study followed for 12.5 years. Cox proportional hazards determined associations of CAC with CV events (CV death, myocardial infarction, stroke, CV revascularization, or hospitalization for heart failure or atrial fibrillation), adjusted for age, sex, race, smoking, HTN, diabetes, hyperlipidemia, HDL cholesterol, and CKD. Interactions for CKD (defined as eGFR<60 mL/min/1.73m2 or albuminuria) and HTN (blood pressure >140/90 mmHg or on medication therapy for HTN) with CAC were tested at various CAC cutoffs, with P<0.1 considered significant.


There were 170 (7.4%) participants with CKD and 811 (35.4%) with HTN. There were 232 CV events: 161 (19.9%) in those with HTN vs. 71 (4.8%) without HTN, and 60 (35.3%) in those with CKD vs. 172 (8.1%) without CKD, P<0.01 for each. CAC was associated with CV events in all non-CKD and non-HTN groups for each CAC cutoff point, but was not associated with CV events at any cutoff in individuals with both CKD and HTN. There was a CKDxCAC interaction for a CAC cutoff of 10 Agatston units, aHR 3.12 (2.20, 4.42) in non-CKD and 1.17 (0.68, 1.99) in CKD, P=0.001, but no CKDxCAC interaction for other CAC cutoffs. There was a significant HTNxCAC interaction at all tested cutoffs of CAC, such that CAC was less predictive of CV events in individuals with HTN (Figure).


CAC was more strongly predictive of CV events in individuals without HTN, but did not add to traditional risk factors for predicting CV events in hypertensive CKD participants.

Figure. Adjusted hazard ratios for CV outcomes at multiple CAC cutoffs in CKD and non-CKD individuals, stratified by HTN status


  • NIDDK Support