Abstract: TH-PO702
CKD, Atherosclerotic Plaque Characteristics on Carotid Magnetic Resonance Imaging, and Cardiovascular Outcomes
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Hartsell, Sydney Elizabeth, University of Utah School of Medicine, Salt Lake City, Utah, United States
- Boucher, Robert E., University of Utah School of Medicine, Salt Lake City, Utah, United States
- Navaneethan, Sankar D., Baylor College of Medicine, Sugar Land, Texas, United States
- Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States
- Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
- Haley, William E., Mayo Clinic, Jacksonville, Florida, United States
- Cheung, Alfred K., University of Utah School of Medicine, Salt Lake City, Utah, United States
- Wright, Jackson T., Case Western Research University, Cleveland, Ohio, United States
- Greene, Tom, University of Utah School of Medicine, Salt Lake City, Utah, United States
- Townsend, Raymond R., University of Pennsylvania School of Medicine, Villanova, Pennsylvania, United States
- Balu, Niranjan, University of Washington, Seattle, Washington, United States
- Xu, Dongxiang, University of Washington, Seattle, Washington, United States
- Sun, Jie, University of Washington, Seattle, Washington, United States
- Canton, Gador, University of Washington, Seattle, Washington, United States
- Yuan, Chun, University of Washington, Seattle, Washington, United States
- Beddhu, Srinivasan, University of Utah School of Medicine, Salt Lake City, Utah, United States
Background
CKD is associated with high risk of cardiovascular (CV) events but it is unclear whether greater baseline prevalence and faster progression of atherosclerosis accounts for this phenomenon.
Methods
In a subgroup (N = 465) of Systolic Blood Pressure Intervention Trial (SPRINT) participants, we used carotid MRI to measure plaque presence and morphology at baseline and after 30-months. CKD was defined as baseline eGFR <60 ml/min/1.73m2. Plaque was defined as max wall thickness> 1.5 mm or presence of lipid rich necrotic-core (NC+) or calcified (Ca+) plaques. As only NC+ plaque predicted primary SPRINT CV composite and not any plaque or Ca+ plaque, the current analysis used NC+ plaques. We related CKD status with NC+ plaque and the CV outcome.
Results
Overall, 196 (42%) patients had CKD and 137 (30%) had NC+ plaques. Baseline presence of NC+ plaque was unrelated to CKD status (OR 1.02, 95% CI 0.67 to 1.57). CKD was associated with a lower odds of NC+ plaque progression (OR 0.42, 95% CI 0.18 to 0.98) among participants with NC+ plaque at baseline and non-missing follow-up MRI (N = 96). There were 28 CV events over 1764 participant-years of follow-up. In a multivariable Cox model, both CKD (HR 3.47, 95% CI 1.42 to 8.47) and NC+ plaque (HR 2.58, 95% CI 1.07 to 6.18) were associated with an increased hazard of CV event. The interaction p-value for CKD status and NC+ plaque was non-significant (p = 0.55). However, patients with both had a significantly higher cumulative rate of CV events compared to patients with neither (Fig. 1).
Conclusion
We found no association between CKD status and the presence or progression of NC+ plaques, although both were independently associated with CV events. Thus, CKD may contribute to CV disease principally via mechanisms other than atherosclerosis. Moreover, a combination of carotid MRI and GFR estimation could be used to identify patients with hypertension at exceptionally high CV risk.
Figure 1: CV Risk Comparison By NC+ plaque and CKD Status.
Funding
- NIDDK Support