Currently, the population is increasing globally, and the number of risk factors for cardiovascular events (CVEs) is increasing due to dynamic changes in regions’ social and economic status. The prevalence of CVE risk factors in patients with comorbidities is unclear.

OBJECTIVE

To analyze risk factors of cardiovascular events and renal dysfunction in middle-aged, elderly, and senile patients with comorbidities.

MATERIAL AND METHODS

A one-stage cross-sectional (retrospective) study of 228 patients with comorbidities was conducted. The incidence of lipid, fat, carbohydrate, phosphate metabolism disorders, anemia, proteinuria, and concentration of serum inflammatory markers and renal dysfunction category were assessed concerning age and sex. Patients were divided into three groups by age: 45—59 years old (n=103), 60—74 years (n=103), and 75—90 years (n=22). The renal dysfunction category was determined based on the serum cystatin C measurement and the calculation of glomerular filtration according to the F. Hoek method. The data were analyzed using Student’s t-test, Mann-Whitney, and ANOVA tests.

RESULTS

In the middle-aged group of patients (45—59 years), the incidence of overweight, grade I obesity, hypercholesterolemia (HC), hypertriglyceridemia (HTG), and dyslipidemia (DL) was 35.9%, 26.2%, 39.8%, 30.0%, and 44.6%, respectively. Laboratory tests showed anemia, hyperglycemia, hyperphosphatemia, and proteinuria in 22.3%, 35.9%, 23.3%, and 36.8% of patients, respectively. The C2 category of renal filtration function was observed in 48.5% of patients (54% of males and 46% of females). C3 «A», C3 «B», C4, and C5 grades of decreased renal filtration were noted in 13.6%, 13.6%, 9.7%, and 4.9% of patients, respectively. The rate of grade II and III obesity was significantly higher in females (p<0.05). Serum creatinine and cystatin C concentrations were significantly higher, and the estimated glomerular filtration rate (eGFR) was lower in males. Middle-aged females were significantly more likely to have high C-reactive protein levels (CRP, 32.6%) than the elderly (23.0%). The prevalence of proteinuria in males was 61.4%. In patients aged 60—74, the incidence of overweight, grade I, II, and III obesity was 35.9%, 28.1%, 9.7%, and 5.8%, respectively. The C2 category of renal filtration function was observed in 40.8% of patients (18 males and 24 females). C3 «A» and C3 «B» stages of eGFR decrease were noted in 26.2% and 16.5% of patients, respectively. The following findings were obtained for the elderly: HC (33.0%), HTG (35.9%), DL (33.9%), hyperglycemia (22.3%), and hyperphosphatemia (23.3%). The rate of HC, HTG, and DL in males and females was 7 (13.7%) and 27 (51.9%), 16 (31.3%) and 21 (40.3%), 12 (23.5%) and 27 (51.9%), respectively. The incidence of hyperglycemia was significantly higher in older females. Levels of CRP, tumor necrosis factor (TNF-α), and interleukin-6 (IL-6) were increased in 28.1%, 8.7%, and 5.8% of patients, respectively. Elevated CRP levels were observed more frequently in elderly males, while high TNF-α concentrations were more common for females. High levels of CRP, TNF-α, and IL-6 were observed in 50.0%, 4.5%, and 40.9% of 76—90-year-old subjects, respectively. Proinflammatory status and hyperglycemia were more common in older males than females. The rate of HC (27.2%), HTG (22.7%), DL (22.7%), hyperglycemia (59.0%), hyperphosphatemia (13.6%), anemia (27.2%), and proteinuria (40.9%) were statistically significant. The rate of overweight and grade I obesity was 22.7% and 22.7%, respectively. The serum cystatin C levels in older females were significantly higher, and the eGFRs were significantly lower. C2 category of renal dysfunction was observed in 18.1% of patients, and C3 «A» and C3 «B» stages of reduced eGFR were observed in 41.0% and 22.7% of patients, respectively. Regardless of age and sex, a strong correlation was identified between TNF-α concentration, hemoglobin (r= –0.219; p<0.05), low-density lipoprotein cholesterol (r=0.188; p<0.05), and serum cystatin C (r=0.139; p<0.05). A positive correlation was revealed between triglyceride and IL-6 levels (r=0.218; p<0.05). High CRP (r= –0.399; p<0.05), TNF-α (r= –0.205; p<0.05), and IL-6 (r= –0.142; p<0.05) significantly correlated with an eGFR reduction.

CONCLUSION

The observed associations of cardiovascular risk factors, renal dysfunction, and age will help to identify ways of personalized secondary prevention of cardiovascular and renal complications concerning age and gender.