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Original Investigation
July 24/31, 2013

History of Kidney Stones and the Risk of Coronary Heart Disease

Author Affiliations
  • 1Division of Nephrology–Renal Program, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli Hospital, Rome, Italy
  • 2Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
  • 3Department of Urology, Massachusetts General Hospital, Boston
  • 4Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 5Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2013;310(4):408-415. doi:10.1001/jama.2013.8780
Abstract

Importance  Kidney stone disease is common and may be associated with an increased risk of coronary heart disease (CHD). Previous studies of the association between kidney stones and CHD have often not controlled for important risk factors, and the results have been inconsistent.

Objective  To examine the association between a history of kidney stones and the risk of CHD in 3 large prospective cohorts.

Design, Setting, and Participants  A prospective study of 45 748 men and 196 357 women in the United States without a history of CHD at baseline who were participants in the Health Professionals Follow-up Study (HPFS) (45 748 men aged 40-75 years; follow-up from 1986 to 2010), Nurses’ Health Study I (NHS I) (90 235 women aged 30-55 years; follow-up from 1992 to 2010), and Nurses’ Health Study II (NHS II) (106 122 women aged 25-42 years; follow-up from 1991 to 2009). The diagnoses of kidney stones and CHD were updated biennially during follow-up.

Main Outcomes and Measures  Coronary heart disease was defined as fatal or nonfatal myocardial infarction (MI) or coronary revascularization. The outcome was identified by biennial questionnaires and confirmed through review of medical records.

Results  Of a total of 242 105 participants, 19 678 reported a history of kidney stones. After up to 24 years of follow-up in men and 18 years in women, 16 838 incident cases of CHD occurred. After adjusting for potential confounders, among women, those with a reported history of kidney stones had an increased risk of CHD than those without a history of kidney stones in NHS I (incidence rate [IR], 754 vs 514 per 100 000 person-years; multivariable hazard ratio [HR], 1.18 [95% CI, 1.08-1.28]) and NHS II (IR, 144 vs 55 per 100 000 person-years; multivariable HR, 1.48 [95% CI, 1.23-1.78]). There was no significant association in men (IR, 1355 vs 1022 per 100 000 person-years; multivariable HR, 1.06 [95% CI, 0.99-1.13]). Similar results were found when analyzing the individual end points (fatal and nonfatal MI and revascularization).

Conclusions and Relevance  Among the 2 cohorts of women, a history of kidney stones was associated with a modest but statistically significantly increased risk of CHD; there was no significant association in a separate cohort of men. Further research is needed to determine whether the association is sex-specific.

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