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Elevated Cardiac Risk Score by ASCVD Calculation is
Associated with Albuminuria in Older People Living with HIV
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ID Week 2019 Oct 2-6 Wash DC
Reported by Jules Levin
Carrie Johnston, MD, Kene Ifeagwu, Eugenia Siegler MD, Heather Derry, PhD, Chelsie Burchett, Michelle Rice, Mary Choi, MD, Marshall Glesby, MD, PhD.
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Congestive Heart Failure and Chronic Kidney Disease The CardioRenal/NephroCardiology Connection - EDITORIAL COMMENT http://www.natap.org/2019/HIV/060519_03.htm
Cardiac disease and chronic kidney disease (CKD) are inextricably linked. The graded risk of cardiovascular morbidity and mortality is strongly related to both declining estimated glomerular filtration rate (eGFR) and severity of albuminuria. This is evident for patients with CKD and heart failure; incidence of heart failure was 3-fold higher in subjects in the ARIC (Atherosclerosis Risk In Communities) study who had eGFRs of <60 ml/min/1.73 m2 than for those with eGFRs of ≥90 ml/min/1.73 m2 (1). Reduced eGFR and albuminuria are associated with increased mortality and heart failure hospitalizations in individuals with heart failure with reduced or preserved left ventricular (LV) systolic function (2,3). Moreover, the triad of CKD, heart failure, and diabetes may coexist in older adult patients, and each condition is responsible for a disproportionately large percentage of Medicare expenditures (Figure 1).
Arterial Stiffness in the Heart Disease of CKD - Kidney/Cardio Connection http://www.natap.org/2019/HIV/060519_01.htm
The link between CKD and cardiovascular (CV) events is well recognized.1-3 CV risk increases in a graded fashion with progressive decrease in kidney function and reaches a zenith in ESRD, but can be reduced by renal transplantation. It is widely accepted that only part of this excessive CV risk is explained by traditional risk factors. The relationship between CKD and chronic cardiac dysfunction is complex and has been named cardiorenal syndrome type 4 or cardio-renal link.1,2. Arterial stiffness is a vascular biomarker4 that is increased in patients with CKD,5-8 even in those with a mildly impaired renal function,5 and is associated with an independent increase in CV risk.7,8 Conversely, at least in patients with advanced CKD, the reduction in aortic stiffness is associated with an improved survival independent of BP changes.7 The increase of arterial stiffness in CKD is mostly caused by reduced renal excretion of vascular toxins, maladaptive metabolic and hormonal processes, and as a result, premature vascular aging. Also, in ESRD, RRT (dialysis) plays a role in the stiffening process and its consequences. Several therapeutic options have been proposed to reduce arterial stiffness, but most of them have been tested primarily in other settings (i.e., hypertension and diabetes).
Kidney Disease, Risk Factor for CVD http://www.natap.org/2019/HIV/061919_01.htm
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Elevated Cardiac Risk Score by ASCVD Calculation is
Associated with Albuminuria in Older People Living with HIV
ID Week 2019 Oct 2-6 Wash DC
Reported by Jules Levin
Carrie Johnston, MD, Kene Ifeagwu, Eugenia Siegler MD, Heather Derry, PhD, Chelsie Burchett, Michelle Rice, Mary Choi, MD, Marshall Glesby, MD, PhD.
Elevated cardiac risk was correlated with moderate-severely elevated albuminuria, suggesting common metabolic and inflammatory pathophysiologic mechanisms. Nearly half (48%) of participants with ASCVD 10-year risk score >7.5% were not on statin therapy, and despite evidence of increased risk of cardiac events with abacavir use, 19% were on antiretroviral regimens that included this drug. Our data suggest that there is room to optimize cardiovascular disease prevention in OPH.
Limitation- small N, no clnical endpoints such as cardiac events
Chronic non-communicable diseases such as kidney dysfunction and cardiac disease are associated with greater morbidity and mortality in older persons living with HIV (OPH), and can be assessed by estimated glomerular filtration rate (eGFR), measurement of albuminuria, and calculation of the 10-year ASCVD Risk Score. Here we describe eGFR and albuminuria in OPH, and assess for a relationship with ASCVD risk score.
Schouten, J. et al. Cross-sectional Comparison of the Prevalence of
Age-Associated Comorbidities and Their Risk Factors
Between HIV-Infected and Uninfected Individuals:
The AGEhIV Cohort Study. Clinical Infectious Diseases,
Volume 59, Issue 12, 15 December 2014, Pages 1787-1797
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