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Association of renal damage with cardiovascular diseases is independent of individual cardiovascular risk profile in hypertension: data from the Italy-Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease study

Sciarretta, Sebastianoa; Valenti, Valentinaa; Tocci, Giulianoa; Pontremoli, Robertob; Rosei, Enrico Agabitic; Ambrosioni, Ettored; Costa, Vittoriod; Leonetti, Gastonee; Pessina, Achille Cesaref; Trimarco, Brunog; Chin, Dianaa; Paneni, Francescoa; Deferrari, Giacomob; Ferrucci, Andreaa; Volpe, Massimoa,h

doi: 10.1097/HJH.0b013e3283326718
Original papers: Epidemiology

Objectives In the past years, several risk charts have been created to increase the accuracy of cardiovascular risk stratification. The most widely used and validated algorithms do not included target organ damage as risk prediction. The aim of the present study was to evaluate whether preclinical renal damage is associated with cardiovascular diseases independently of individual risk profile assessed by risk charts.

Methods The study population was that of Italy-Developing Education and awareness on MicroAlbuminuria in patients with hypertensive Disease, a large observational study conducted on hypertensive patients in Italy. The Framingham Risk Score (FRS), Systematic COronary Risk Estimation (SCORE) and Progetto Cuore Risk Score (Progetto Cuore RS) were computed in each eligible patient. Chronic kidney disease was defined by the presence of albuminuria or by a reduction of glomerular filtration rate.

Results Study participants were categorized to have low, medium and high risk according to the tertiles of the three charts. Prevalence of total cardiovascular diseases progressively and significantly increased according to the degrees of risk assessed by the three charts, the highest prevalence being in participants with a high-risk profile (both high and medium vs. low risk <0.01 for FRS, SCORE and Progetto Cuore RS). The presence of chronic kidney disease was associated with total cardiovascular diseases, independently of FRS (odds ratio 1.64, 95% confidence interval 1.33–2.02, P < 0.001), SCORE (odds ratio 1.55, 95% confidence interval 1.21–1.98, P < 0.001) and Progetto Cuore RS (odds ratio 1.59, 95% confidence interval 1.22–2.07, P < 0.001). Moreover, inclusion of renal damage in the logistic model significantly increased the accuracy of the FRS (P < 0.05), SCORE (P < 0.01) and Progetto Cuore RS (P < 0.01) to identify patients with overt cardiovascular diseases.

Conclusion Identification of patients with preclinical renal damage should be encouraged in the hypertension cardiovascular risk stratification setting in order to achieve a more accurate individual risk computation. The presence of renal damage could improve cardiovascular risk prediction over the widely used risk stratification charts.

aII Faculty of Medicine, University of Rome ‘Sapienza’, Division of Cardiology, S. Andrea Hospital, Rome, Italy

bDepartment of Internal Medicine, Azienda Ospedaliera Universitaria San Martino, Genoa, Italy

cDepartment of Internal Medicine, University of Brescia, Brescia, Italy

dDepartment of Internal Medicine, University of Bologna, Bologna, Italy

eIstituto Auxologico Italiano, Ospedale S. Luca, Milan, Italy

fDepartment of Clinical and Experimental Medicine, University of Padova, Padua, Italy

gDepartment of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy

hIRCCS Neuromed, Polo Molisano, University of Rome ‘Sapienza’, Pozzilli, Italy

Received 25 June, 2009

Revised 14 August, 2009

Accepted 27 August, 2009

Correspondence to Professor Massimo Volpe, MD, FAHA, FESC, Cardiology Department, 2nd Faculty of Medicine, University of Rome ‘La Sapienza’, Via di Grottarossa 1039, Rome 00189, Italy Tel: +39 06 33775561; fax: +39 06 33775061; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.