Renal function is associated with arterial stiffness and predicts outcome in patients with coronary artery disease

BACKGROUND: Arterial stiffness (AS) is associated, and a predictor of, outcome in patients with cardiovascular and renal disease. AIM: In this study, we estimated glomerular filtration rate (eGFR) and measured indices of AS in patients with suspected coronary artery disease (CAD), and assessed their predictive value on outcome. DESIGN: Prospective cohort study. METHODS: AS was measured using pulse wave velocity (PWV) and pulse wave analysis in patients with no known renal disease who had recently undergone coronary angiography. Renal function was assessed using serum creatinine concentration [creat](sr) and eGFR (Cockcroft & Gault, C&G). The primary endpoint was a combination of hospitalization due to cardiovascular disease and all-cause mortality. RESULTS: Two hundred eighty-four subjects (210 men, 74 women, mean age 62 years) were followed-up for a mean of 1.5 years. PWV was negatively associated with eGFR (r(2) = 0.09, P < 0.001), even in patients with an eGFR > or =60 ml/min/m(2) (r(2) = 0.04, P < 0.01). PWV was determined by age, heart rate, systolic blood pressure, body mass index and [creat](sr) (r(2) = 0.38, P < 0.001). A lower eGFR (P < 0.01), PWV above the median (P < 0.05) and degree of CAD (P < 0.001) predicted a shorter time to the primary endpoint. eGFR and degree of CAD remained independent determinants of outcomes (P < 0.01), even in patients with normal renal function (P < 0.01). CONCLUSION: This study suggests that even minor reductions in eGFR, within the normal range, are an additional independent risk marker in patients with CAD.