THE INCREASED RISK OF CORONARY HEART-DISEASE ASSOCIATED WITH NEPHROTIC SYNDROME

Patients with nephrotic syndrome (NS) are believed to be at increased risk of atherosclerosis and coronary heart disease (CHD), although exi sting evidence for this association has not been persuasive. The risk of CHD among 142 persons with NS documented by protein-uria greater-th an-or-equal-to 3.5 g daily was compared with that among 142 matched co ntrols randomly selected from the membership of a large Northern Calif ornia health plan. Controls were matched for sex, year of birth, and p resence in the health plan when the referent case was diagnosed. No di abetics were included in this study. Mean follow-up for nonfatal CHD e vents was 5.6 years for NS subjects and 11.2 years for controls. Among the NS subjects myocardial infarction (MI) developed in 11, and there were 58 deaths, seven because of CHD. Among the controls, there were four MIs and 10 deaths, three because of CHD. In matched-pair analysis , there were 11 MIs among NS subjects and none among controls [P = 0.0 01, lower bound of 95% confidence interval for relative risk (CI), 2.8 1. In an unmatched analysis adjusted for hypertension and smoking at d iagnosis of NS, the relative risk of MI was 5.5 (95% CI 1.6 to 18.3) a nd the relative risk of coronary death was 2.8 (95% CI 0.7 to 11.3). O mitting data of NS subjects with minimal change disease and systemic l upus erythematosus yielded similar results. These data suggest that pe rsons with NS are at increased risk of CHD.