Impaired renal function ups cardiovascular risk in young adults

Estimated glomerular filtration rate (eGFR) below age-expected values appears to indicate an increased risk for major adverse cardiovascular events (MACE) and MACE plus heart failure (MACE+) in young adults, according to a study.

In this retrospective cohort study, the researchers assessed a total of 8.7 million individuals (3.6 million aged 18‒39 years) using linked provincial healthcare data sets from Ontario, Canada from January 2008 to March 2021. Participants had a mean age of 41.3 years and mean eGFR of 104.2 mL/min/1.73 m².

The association of categorized eGFR (50‒120 mL/min/1.73 m²) with MACE (first of cardiovascular mortality, acute coronary syndrome, and ischaemic stroke) and MACE+, stratified according to age (ie, 18‒39, 40‒49, and 50‒65 years), was analysed using Cox models.

Over a median follow-up of 9.2 years, the relative risk of both MACE and MACE+ was increased as early as eGFR <80 mL/min/1.73 m² in young adults (eg, for MACE, at eGFR 70‒79 mL/min/1.73 m², ages 18‒30 years: 2.37 events per 1,000 person-years; hazard ratio [HR], 1.31, 95 percent confidence interval [CI], 1.27‒1.40; ages 40‒49 years: 6.26 events per 1,000 person-years; HR, 109, 95 percent CI, 1.06‒1.12; ages 50‒65 years: 14.9 events per 1,000 person-years; HR, 1.07, 95 percent CI, 1.05‒1.08).

These findings were maintained for each MACE component and in further analyses (stratifying according to past cardiovascular disease, accounting for albuminuria at index, and using repeated eGFR measures).

“In young adults, eGFR below age-expected values were associated with an elevated risk for MACE and MACE+, warranting age-appropriate risk stratification, proactive monitoring, and timely intervention,” the researchers said.