Impaired Renal Function and Major Cardiovascular Events in Young Adults

Junayd Hussain; Haris Imsirovic; Mark Canney; Edward G Clark; Meghan J Elliott; Pietro Ravani; Peter Tanuseputro; Ayub Akbari; Gregory L Hundemer; Tim Ramsay; Navdeep Tangri; Greg A Knoll; Manish M Sood

doi:10.1016/j.jacc.2023.07.012

Impaired Renal Function and Major Cardiovascular Events in Young Adults

J Am Coll Cardiol. 2023 Sep 26;82(13):1316-1327. doi: 10.1016/j.jacc.2023.07.012.

Authors

Affiliations

¹ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada.
² ICES, Ottawa, Ontario, Canada.
³ Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁴ Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Division of Nephrology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyere Research Institute, Ottawa, Ontario, Canada.
⁶ Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁷ ICES, Ottawa, Ontario, Canada; Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁸ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
⁹ Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ ICES, Ottawa, Ontario, Canada; Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: msood@toh.ca.

PMID: 37730288
DOI: 10.1016/j.jacc.2023.07.012

Abstract

Background: Cardiovascular (CV) disease in young adults (aged 18-39 years) is on the rise. Whether subclinical reductions in kidney function (ie, estimated glomerular filtration rate [eGFR] above the current threshold for chronic kidney disease but below age-expected values) are associated with elevated CV risk is unknown.

Objectives: The goal of this study was to examine age-specific associations of subclinical eGFR reductions in young adults with major adverse cardiovascular events (MACEs) and MACE plus heart failure (MACE+).

Methods: A retrospective cohort study of 8.7 million individuals (3.6 million aged 18-39 years) was constructed using linked provincial health care data sets from Ontario, Canada (January 2008-March 2021). Cox models were used to examine the association of categorized eGFR (50-120 mL/min/1.73 m²) with MACE (first of CV mortality, acute coronary syndrome, and ischemic stroke) and MACE+, stratified according to age (18-39, 40-49, and 50-65 years).

Results: In the study cohort (mean age 41.3 years; mean eGFR 104.2 mL/min/1.73 m²; median follow-up 9.2 years), a stepwise increase in the relative risk of MACE and MACE+ was observed as early as eGFR <80 mL/min/1.73 m² in young adults (eg, for MACE, at eGFR 70-79 mL/min/1.73 m², ages 18-30 years: 2.37 events per 1,000 person years [HR: 1.31; 95% CI: 1.27-1.40]; ages 40-49 years: 6.26 events per 1,000 person years [HR: 1.09; 95% CI: 1.06-1.12]; ages 50-65 years: 14.9 events per 1,000 person years [HR: 1.07; 95% CI: 1.05-1.08]). Results persisted for each MACE component and in additional analyses (stratifying according to past CV disease, accounting for albuminuria at index, and using repeated eGFR measures).

Conclusions: In young adults, eGFR below age-expected values were associated with an elevated risk for MACE and MACE+, warranting age-appropriate risk stratification, proactive monitoring, and timely intervention.

Keywords: cardiovascular disease; chronic; epidemiology; hypertension; kidney failure; prevention.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Coronary Syndrome*
Adult
Humans
Kidney / physiology
Ontario / epidemiology
Renal Insufficiency*
Retrospective Studies
Young Adult