[1362] NEPHROLITHIASIS AND THE RISK OF CARDIOVASCULAR DISEASE

Brian H Eisner, MD, Matthew R Cooperberg, MD, Gary C Curhan, ScD, MD, Marshall L Stoller, MD. Massachusetts General Hospital, Harvard Medical School, Boston, MA; University of California, San Francisco, School of Medicine, San Francisco, CA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Introduction and Objective: The etiology of nephrolithiasis is incompletely characterized. We have hypothesized that the initial stone event may be vascular in origin, and therefore that patients with nephrolithiasis may manifest systemic vascular disease. We undertook a study to examine whether a history of nephrolithiasis is associated with subsequent development of cardiovascular disease. Methods: A prospective analysis of a large cohort, the Health Professionals Follow-up Study (N=45,988 men, age range at baseline 40-75 years) was performed. Multivariable regression models adjusted for age, body mass index, thiazide diuretic use, anti-hypertensive and cholesterol-lowering medications, tobacco use, history of gout or diabetes mellitus, fluid intake, and other dietary factors. Endpoints were coronary heart disease (CHD), defined as myocardial infarction, angina, or need for coronary artery bypass graft (CABG), and stroke, including ischemic or hemorrhagic cerebrovascular accidents. Results: 4747 (10.3%) patients reported a history of nephrolithiasis at baseline. After adjustment for potential confounders, the multivariate relative risk (RR) of CHD among men with a history of nephrolithiasis compared to those without nephrolithiasis was 1.15 (95% CI, 1.06-1.26; P=0.001). Relative risks for individual outcomes included a RR of 1.16 for myocardial infarction (95% CI, 1.02-1.33; P=0.03), 1.26 for angina (95% CI, 1.01-1.60; P=0.04), and 1.23 for CABG (95% CI, 1.07-1.40; P=0.003). There was no increased risk of stroke (RR = 1.0, 95% CI, 0.81-1.25; p=0.9). Conclusions: Nephrolithiasis is associated with a modest yet statistically significant increased risk of coronary heart disease. These results are consistent with findings in other recent studies suggesting that nephrolithiasis may reflect a systemic vascular disorder. These findings may contribute to our understanding of the etiology of stone formation, and may be important in counseling stone patients regarding future risk of CHD.