2024. Risk of Cardiovascular Events with Renal Disease: The Ambulatory Care Quality Improvement Project
BA Young, VA Puget Sound Health Care System and University of Washington, EJ Boyko, VA Puget Sound Health Care System and University of Washington, M McDonell, VA Puget Sound Health Care System, SD Fihn, VA Puget Sound Health Care System and University of Washington

Objectives: To determine cardiovascular risk associated with renal insufficiency in a population-based setting.

Methods: We conducted a prospective study using data from 35,882 veterans from 7 VA General Internal Medicine Clinics who were enrolled in the Ambulatory Care Quality Improvement Project (ACQUIP). Patients were included if they had a serum creatinine (CR) level during the period 2 years prior to entry into the study and ending after the first year of enrollment. Average creatinine for this period was examined with respect to the incidence of cardiovascular events during the 2.5 years of the project, as indicated by inpatient or outpatient diagnoses of myocardial infarction (ICD-9 410 and 411), angina (413), chronic ischemic disease (414) or congestive heart failure (428).

Results:  Compared with non-enrollees, ACQUIP enrollees were slightly older, were more likely to be Caucasian (72% vs. 48%) and to be on lipid or antihypertensive medications. Veterans with renal insufficiency (CR>1.5) were more likely to be older, male (99%), married and from an ethnic group other than Caucasian than those without renal insufficiency.  Veterans with elevated creatinine levels had a step-wise increase in risk for cardiovascular events as percentile of creatinine increased. Compared with veterans in the 75th percentile or less for creatinine (0.10-1.20 mg/dl), veterans in the 75th-90th percentile (1.2-1.5 mg/dl) had 1.1 fold higher relative risk (95% CI=1.0,1.3), those in the 90th 99th percentile (1.5-3.0 mg/dl) had a 1.9-fold higher relative risk (95% CI=1.6-2.2), and those in the 99th percentile and above (>=3.0 mg/dl) had 2.3-fold higher risk (95% CI=1.6,3.2), after adjusting for patient demographics, medications and comorbid conditions. When results were compared by ethnicity, African American veterans were more likely to have been in the 75Th-99th percentile of creatinine than whites, but had a 20% decrease in risk of a cardiovascular event (RR= 0.8, 95% CI = 0.7-0.9).

Conclusions: Renal insufficiency was independently associated with an elevated risk of cardiovascular events.African Americans were at a lower risk of cardiovascular events independent of elevated renal function.

Impact: Renal insufficiency is a significant risk factor for cardiovascular events in the general veteran population. However, cardiovascular risk may be modified by ethnicity.