(Stroke. 1997;28:557-563.)
© 1997 American Heart Association, Inc.
Articles |
Serum Creatinine Concentration and Risk of Cardiovascular Disease
A Possible Marker for Increased Risk of Stroke
From the Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, UK.
Correspondence to Dr S. Goya Wannamethee, Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, Rowland Hill St, London, NW3 2PF, UK.
Background and Purpose Elevated serum creatinine has been associated with increased mortality in hypertensive persons, the elderly, and patients with myocardial infarction or stroke in whom cardiovascular disease is the major cause of death. We have examined the relationship between serum creatinine concentration and the risk of major ischemic heart disease and stroke events and all-cause mortality in a general population of middle-aged men.
Methods We present a prospective study of middle-aged men (aged 40 to 59 years) drawn from 24 British towns who have been followed up for an average of 14.75 years. Data on serum creatinine were available for 7690 men in whom there were 287 major stroke events, 967 major ischemic heart disease events, and 1259 deaths from all causes during follow-up.
Results The median serum creatinine concentration was
98 µmol/L (95% range, 76 to 129 µmol/L). Stroke risk was
significantly increased at levels above 116 µmol/L (90th
percentile) even after adjustment for a wide range of cardiovascular
risk factors (relative risk [RR], 1.6; 95% CI, 1.1 to 2.1;
116 µmol/L versus the rest). Risk of a major ischemic
heart disease event was significantly increased at or above 130
µmol/L (97.5 percentile), but this was attenuated after adjustment
(RR, 1.2; 95% CI, 0.8 to 1.7; 130 µmol/L versus the rest).
There was a weak but significant positive association between diastolic
blood pressure and creatinine concentration. However, elevated
creatinine concentration (116 µmol/L) was associated with a
significant increase in stroke in both normotensive and hypertensive
men. All-cause mortality and overall cardiovascular mortality were
significantly increased only above the 97.5 percentile, and no
significant association was seen with cancer or other noncardiovascular
mortality.
Conclusions A high serum creatinine concentration within the normal range is a marker for increased risk of cerebrovascular disease in both normotensive and hypertensive subjects. These findings support the evidence indicating that subtle impairment of renal function is a factor for increased risk of stroke and suggest mechanisms in the pathogenesis of stroke that warrant further investigation.
Key Words: cardiovascular disorders • creatinine • mortality • risk factors
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