Mild renal dysfunction associated with incident coronary artery disease in young males

Aims: Although impaired renal function is associated with adverse cardiovascular outcomes, it is unknown whether this association exists in young, healthy adults with normal or mildly impaired renal dysfunction. Methods and results: We calculated the baseline creatinine clearance of young males without antecedent diabetes mellitus, coronary artery disease (CAD), or renal dysfunction, and examined their subsequent diagnosis of CAD, defined as coronary artery diameter stenosis of at least 50% and/or myocardial infarction. The 23 964 males, 32.5 ± 5.9 years old, had a baseline estimated creatinine clearance of 107.9 ± 0.6 mL min^-1 per 1.73 m² (60-150 mL min^-1 per 1.73 m²). During a mean follow-up of 3.5 ± 1.9 years, 77 subjects were diagnosed with CAD. After age adjustment, there was a progressive increase in the risk for CAD as the estimated creatinine clearance decreased [hazard ratio (HR) 4.77, 95% confidence interval 3.22-7.06, P < 0.001 for comparison between the fifth and first quintiles]. This association also persisted after further adjustments for conventional and ancillary risk factors for CAD (HR 2.10, 95% confidence interval 1.40-3.14, P < 0.001). Conclusion: Reduced renal function in the normal to mildly impaired range is independently associated with increased risk for CAD among young, healthy males.