DENVER — Even moderate kidney dysfunction is a strong indicator of increased sudden cardiac death risk in postmenopausal women with coronary heart disease, according to a new secondary analysis of the landmark Heart and Estrogen Replacement Study (HERS).
Renal impairment was previously reported to be associated with increased risk of sudden cardiac death (SCD) in the second Multicenter Automated Defibrillator Implantation Trial (MADIT-2) and the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) Trial. But those studies mainly involved men with advanced chronic heart failure and severely depressed left ventricular ejection fraction, which raised a question regarding generalizability. The new HERS finding extends the observation that renal impairment raises SCD risk to a female and much healthier population, Dr. Rajat Deo said at the annual meeting of the Heart Rhythm Society.
HERS was a double-blind clinical trial in which 2,763 postmenopausal women with documented coronary heart disease (CHD) were randomized to conjugated estrogens plus medroxyprogesterone acetate or placebo and followed for 6.8 years.
During follow-up there were 48 SCDs among the 1,302 women with a baseline estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m
That's an incidence of SCD of about 0.5% per year in patients with an eGFR above 60, compared with 0.75% per year in those with moderate kidney dysfunction and nearly 1.5% annually in those with advanced renal dysfunction, said Dr. Deo of Johns Hopkins University, Baltimore.