An international team of investigators has found that mild to moderate reduction in kidney function may cause cardiovascular disease, even in people without symptoms of heart disease or diabetes.
“This highlights to the world why treating kidney disease early is so important,” said Adriana Hung, MD, MPH, associate professor of Medicine at Vanderbilt University Medical Center and a senior co-author of the report, published Nov. 15 in the journal Circulation.
Investigators from VUMC, the University of Cambridge, Harvard Medical School, and the Department of Veterans Affairs (VA) analyzed data from more than 648,000 people enrolled in two large European studies, the UK (United Kingdom) Biobank, and the VA’s Million Veteran Program (MVP).
Since it was launched in 2011, the MVP has recruited 903,000 veterans to study genetic contributions to disease. Nearly 25,000 have joined the study through the Nashville VA Medical Center, adjacent to VUMC.
Hung, a nephrologist and epidemiologist, is medical director of the Nashville VA dialysis unit and principal investigator of a national MVP research project entitled “Genetics of CKD and Hypertension — Risk Prediction and Drug Response in the MVP.”
End-stage renal disease (kidney failure) has long been associated with cardiovascular disease, but until now it was not known what impact, if any, a mild to moderate reduction in kidney function had on the development of heart disease.
To find out, the researchers constructed a genetic risk score for each research subject based on more than 200 genetic variations that are associated with kidney function.
Using that score, they then conducted a Mendelian randomization analysis and found that even mildly impaired kidney function may cause heart disease. This effect was independent of traditional cardiovascular risk factors like high blood pressure and high circulating levels of glucose, cholesterol and lipids.
The results imply that cardiovascular disease risk can be potentially reduced through lifestyle changes and medications that protect and maintain kidney function.
Long-term clinical trials will be needed to prove that preserving kidney health is good for the heart. In the meantime, insights gained from this study could lead to new treatments and interventions, Hung said.
The first author, Liam Gaziano, PhD, is a researcher with the University of Cambridge, Harvard Medical School, and the VA Boston Healthcare System.
Other Vanderbilt researchers who participated in this investigation included Cassianne Robinson-Cohen, PhD, Elvis Akwo, MD, PhD, and Todd Edwards, PhD, MS.
