European Heart Journal Advance Access originally published online on November 28, 2006
European Heart Journal 2006 27(24):2975-2981; doi:10.1093/eurheartj/ehl402
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Renal function and cardiovascular mortality in elderly men: the role of inflammatory, procoagulant, and endothelial biomarkers
1 Department of Primary Care and Population Sciences, Royal Free and, University College Medical School, Rowland Hill Street, London NW3 2PF, UK
2 Division of Cardiovascular and Medical Sciences, University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK
3 Division of Community Health Sciences, St George's University of London, London SW17 ORE, UK
Received 19 June 2006; revised 2 November 2006; accepted 7 November 2006; online publish-ahead-of-print 28 November 2006.
* Corresponding author. Tel: +44 20 7830 2239; fax: +44 20 7794 1224. E-mail address: goya{at}pcps.ucl.ac.uk
Aims To assess the extent to which inflammatory, procoagulant, and endothelial biomarkers modify the relationship between diminished renal function and cardiovascular mortality.
Methods and results Prospective study of 4029 men aged 60–79 years followed up for a mean period of 6 years, during which 304 cardiovascular deaths occurred. Predicted estimated glomerular filtration rate (eGFR) was used as a measure of renal function. Reduced eGFR was associated with increased prevalence of established cardiovascular risk factors [cardiovascular disease, diabetes, hypertension, left ventricular (LV) hypertrophy, and dyslipidaemia] and higher levels of inflammatory markers [interleukin 6 (IL-6), C-reactive protein], endothelial markers [von Willebrand factor (vWF) and tissue plasminogen activator], activated coagulation markers (fibrin D-dimer), and blood viscosity. Cardiovascular mortality risk increased with decreasing levels of eGFR, particularly among men with eGFR <60 mL/min per 1.73 m2 even after adjustment for established risk factors (adjusted RR 1.49, 95% CI 1.10, 2.03; <60 vs. 
70 mL/min per 1.73 m2). The association was attenuated after further adjustment for vWF, D-dimer, and IL-6 (adjusted RR 1.34, 95% CI 0.98–1.82).
Conclusion Mild-to-moderate renal insufficiency is associated with significantly increased cardiovascular mortality in elderly men, which is partly explained by the increased prevalence of established risk factors, markers of coagulation, endothelium, and inflammation.
Key Words: Renal function • Cardiovascular mortality • Inflammation • Coagulation • Endothelial dysfunction
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