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(Circulation. 2002;105:2826.)
© 2002 American Heart Association, Inc.

Brief Rapid Communications

Mild Renal Insufficiency Is Associated With Angiographic Coronary Artery Disease in Women

Steven E. Reis, MD; Marian B. Olson, MS; Linda Fried, MD, MPH; Virginia Reeser, PA-C; Sunil Mankad, MD; Carl J. Pepine, MD; Richard Kerensky, MD; C. Noel Bairey Merz, MD; Barry L. Sharaf, MD; George Sopko, MD, MPH; William J. Rogers, MD; Richard Holubkov, PhD

From the Cardiovascular Institute (S.E.R., V.R.), the Department of Epidemiology (M.B.O., R.H.), and the VA Pittsburgh Healthcare System Department of Medicine (L.F.), University of Pittsburgh, Pittsburgh, Pa; Division of Cardiology (S.M.), MCP-Hahnemann School of Medicine, West Penn-Allegheny Health System, Pittsburgh, Pa; Division of Cardiology (C.J.P., R.K.), University of Florida, Gainesville, Fla; Division of Cardiology (C.N.B.M.), Cedars-Sinai Medical Center, Los Angeles, Calif; Division of Cardiology (B.L.S.), Rhode Island Hospital, Providence, RI; Division of Heart and Vascular Diseases (G.S.), National Heart, Lung, and Blood Institute, Bethesda, Md; and Division of Cardiology (W.J.R.), University of Alabama at Birmingham.

Correspondence to Steven E. Reis, MD, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213. E-mail reisse{at}msx.upmc.edu

Background— Mild renal insufficiency is associated with an increased risk for cardiovascular events in women with coronary artery disease (CAD). However, the relationship between mild renal insufficiency and atherosclerotic CAD in women is not known.

Methods and Results— Women with chest pain who were referred for coronary angiography in the NHLBI Women’s Ischemia Syndrome Evaluation (WISE) study underwent quantitative coronary angiography, blood measurements of creatinine, lipids, and homocysteine, and assessment of CAD risk factors. Fifty-six women had mild renal insufficiency (serum creatinine 1.2 to 1.9 mg/dL), and 728 had normal renal function (creatinine <1.2 mg/dL). Creatinine correlated with angiographic CAD severity score (r=0.11, P<0.004) and maximum coronary artery stenosis (r=0.11, P<0.003). Compared with women with normal renal function, those with mild renal insufficiency were more likely to have significant angiographic CAD (50% diameter stenosis in 1 coronary artery) (61% versus 37%; P<0.001) and CAD in multiple vessels (P<0.001 for association) and had greater maximum percent diameter coronary stenosis (59±35% versus 38±36%; P<0.001). Mild renal insufficiency was associated with significant angiographic CAD independent of age and risk factors (OR=1.9, 95%CI=1.1 to 3.5). After controlling for homocysteine in 509 women, mild renal insufficiency remained predictive of CAD (OR=3.2, 95%CI=1.4 to 7.2).

Conclusions— In women with chest pain, mild renal insufficiency is an independent predictor of significant angiographic CAD. Mildly increased serum creatinine is probably a marker for unmeasured proatherogenic factors.

Key Words: coronary artery disease • renal insufficiency • women

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