Joint effects of carotid plaques and renal impairment on the risk of cardiovascular disease and all-cause death in a community-based population: The Kailuan cohort study

Objective: It is unknown whether renal impairment and atherosclerosis increase the risk of cardiovascular disease (CVD) and death. Atherosclerosis already raises the risk of CVD and all-cause death. This study investigated the joint effects of carotid plaques and renal impairment on CVD and all-cause death in community-based populations. Methods: The study cohort consisted of 20,416 participants from the Kailuan Study who completed a carotid plaque ultrasound in 2012. A glomerular filtration rate (GFR) of < 60 ml/min or trace semiquantitative proteinuria or higher were both considered signs of renal insufficiency. We divided them into four groups according to the presence of carotid plaque and renal impairment. These groups were categorized as no carotid plaque, estimated glomerular filtration rate (eGFR) ≥ 60 ml/min, and proteinuria < trace; no carotid plaque, eGFR < 60 ml/min, and proteinuria ≥ trace; carotid plaque, eGFR ≥ 60 ml/min and proteinuria < trace; and carotid plaque, eGFR < 60 ml/min, and proteinuria ≥ trace, respectively. We investigated the combined effect of renal impairment and carotid plaque on cardiovascular events and all-cause death in the Kailuan community-based population. Result: Participants with carotid plaque, eGFR < 60 ml/min and proteinuria had a 2.88-fold higher risk of all-cause death (95% CI, 2.18-3.80), which was significantly higher than those with lone factors (HR, 1.57; 95% CI, 1.04-2.36; and HR, 1.91; 95% CI, 1.56-2.32), compared to participants with no carotid plaque, eGFR ≥ 60 ml/min and proteinuria <trace group. Participants with carotid plaque, eGFR < 60 ml/min, and proteinuria had a 1.05-fold higher risk of CVD (95% CI, 0.82-1.35), which was not higher than those with alone factors (HR, 1.35; 95% CI, 1.02-1.80; and HR, 1.12; 95% CI, 0.96-1.30), compared to participants with no carotid plaque, eGFR ≥ 60 ml/min and proteinuria <trace group. Stratified analysis by age, participants with the carotid plaque, eGFR < 60 ml/min and proteinuria had a 2.98-fold higher risk of all-cause death (95% CI: 2.24-3.96), which was significantly higher than participants with lone factors (HR, 1.68; 95% CI, 1.10-2.59; and HR, 1.95; 95% CI, 1.59-2.40), compared to participants with no carotid plaque, eGFR ≥ 60 ml/min and proteinuria <trace group in the age of ≥ 50 years. Participants with carotid plaque, eGFR < 60 ml/min and proteinuria had a 1.66-fold higher risk of CVD (95% CI: 1.29-2.25), which was significantly higher than participants with lone factors (HR, 1.63; 95% CI, 1.20-2.22, and HR, 1.28; 95% CI, 1.11-1.49), compared to participants with no carotid plaque, eGFR ≥ 60 ml/min and proteinuria <trace group, in the age of ≥ 50 years. Conclusion: The joint of carotid plaques and renal impairment may further increase the risk of CVD and all-cause death compared with participants with alone factors in the age of ≥ 50 years, but not in the age of < 50 years, from a community-based study.