10-Year Cardiovascular Risk Score for Coronary Artery Calcification Progression Depending on Prevalent Coronary Artery Calcification in East Asian Patients with CKD: Findings from KNOW-CKD

Background: Chronic kidney disease (CKD) is a well-known risk factor for atherosclerotic cardiovascular disease (ASCVD). However, no established prediction model exists for the progression of coronary artery calcification (CAC) in CKD patients. We investigated the association between CAC progression and 10-year ASCVD risk prediction models in CKD patients, particularly in relation to baseline CAC. Methods: From a nationwide, prospective cohort of Korean patients with CKD, 1,177 were available for CAC progression data analysis. Of these, 809 patients, who were without prevalent ASCVD and eligible for the Pooled Cohort Equation, were included in the study. The main predictor was the 10-year cardiovascular risk score from the Pooled Cohort Equation. Prevalent CAC was defined using computed tomography, with an Agatston score greater than zero. CAC progression was defined as an increase in Agatston score of more than 15% per year at the 4-year follow-up in patients with baseline CAC, while any increase in CAC was defined as progression for those without baseline CAC. For both groups, coronary stenting during the 4-year follow-up period was considered as CAC progression. Results: Prevalent CAC was observed in 394 (48.7%) patients. CAC progression was observed in 104 (25.1%) patients without baseline CAC, and 259 (65.7%) in those with baseline CAC. Compared with 1st quartile, the odds ratios (95% confidence intervals) for CAC progression of 2nd, 3rd, and 4th quartiles were 2.25 (1.48-3.44), 3.29 (2.16-5.01), and 4.27 (2.80-6.52) in unadjusted model, respectively. However, this graded association was disappeared in those with baseline CAC. A consistent association was observed in complete case analysis and different cutoffs for CAC progression (>30%/yr). Conclusion: A higher score on the 10-year risk prediction model is associated with CAC progression in CKD patients without baseline CAC, whereas this association is less pronounced in those with prevalent CAC. Funding: Government Support – Non-U.S.