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(Hypertension. 2008;51:1578.)
© 2008 American Heart Association, Inc.

Original Articles

Kidney Dysfunction and Sudden Cardiac Death Among Women With Coronary Heart Disease

Rajat Deo; Feng Lin; Eric Vittinghoff; Zian H. Tseng; Stephen B. Hulley; Michael G. Shlipak

From the Division of Cardiology (R.D.), Johns Hopkins Hospital, Baltimore, Md; General Internal Medicine Section (M.G.S.), Veterans Affairs Medical Center, and Departments of Medicine, Epidemiology, and Biostatistics (F.L., E.V., S.B.H., M.G.S.), and the Division of Cardiology (Z.H.T.), University of California School of Medicine, San Francisco.

Correspondence to Michael G. Shlipak, University of California, San Francisco, General Internal Medicine Section, VA Medical Center (111A1), 4150 Clement St, San Francisco, CA 94121. E-mail Michael.Shlipak{at}ucsf.edu

We evaluated the association between kidney dysfunction and sudden cardiac death risk among ambulatory women with coronary heart disease. The Heart and Estrogen Replacement Study evaluated the effects of hormone treatment on cardiovascular events among 2763 postmenopausal women with coronary heart disease. Kidney dysfunction was categorized by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Multivariate proportional hazards models were used to adjust for cardiovascular risk factors, congestive heart failure, and myocardial infarction. At baseline, 37% (n=1027) had an eGFR of >60 mL/min, 54% (n=1503) had an eGFR of 40 to 60 mL/min, and 8% (n=230) had an eGFR of <40 mL/min. During the 6.8-year follow-up period, there were 136 adjudicated sudden cardiac deaths. The rate of sudden cardiac death was higher in those with lower kidney function (0.5% per year among those with an eGFR >60; 0.6% per year with an eGFR between 40 and 60; and 1.7% per year with an eGFR <40 mL/min; P for trend <0.001). After multivariate analysis with baseline risk factors, eGFR at 40 to 60 mL/min was not a significant predictor, but eGFR at <40 mL/min remained strongly associated with sudden cardiac death (hazard ratio: 3.2; 95% CI: 1.9 to 5.3); adjustment for incident congestive heart failure and myocardial infarction during follow-up diminished this association (hazard ratio: 2.3; 95% CI: 1.3 to 3.9), suggesting that congestive heart failure and myocardial infarction mediated only part of the association between kidney dysfunction and sudden cardiac death. Advanced kidney dysfunction is an independent predictor of sudden cardiac death among women with coronary heart disease.

Key Words: kidney dysfunction • women • sudden cardiac death

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