***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: This article reports further analyses of the Hypertension Optimal Treatment ( HOT ) Study data with the aim to describe ( 1 ) the value of baseline serum creatinine and its clearance ( estimated by Cockroft and Gault formula ) as predictors of cardiovascular events , ( 2 ) the effects of intensive lowering of BP on cardiovascular events and renal function in patients with reduced renal function , and ( 3 ) the effects on cardiovascular events of adding acetylsalicylic acid to antihypertensive therapy in patients with reduced renal function . The results show that ( 1 ) baseline elevation in serum creatinine and a reduction in estimated creatinine clearance are powerful predictors of cardiovascular events and death . ( 2 ) Reduced renal function at baseline did not preclude the desired control of BP . In contrast to patients with normal renal function , the incidence of major cardiovascular events did not differ in the three groups of patients with mild renal insufficiency r and omized to different diastolic BP targets . No significant changes in serum creatinine were seen at the end of the 3.8-yr treatment period in the great majority of patients . However , there was a small group of patients ( 0.58 % of the total study population ) whose renal function deteriorated ( increase > or = 30 % over baseline and final serum creatinine concentration > or = 2 mg/dl ) despite satisfactory reduction of diastolic BP . ( 3 ) The results of this re analysis of the HOT Study suggest though do not prove that the association of acetylsalicylic acid with intensive antihypertensive therapy offers additional benefit in hypertensive patients with reduced renal function Aim : It is not clear whether elevated serum non-high-density lipoprotein cholesterol  ( non-HDL-C ) levels are a risk factor for cardiovascular disease ( CVD ) in subjects with chronic kidney disease ( CKD ) in the general population . Methods : A total of 2,630 community-dwelling Japanese subjects ( 1,107 men and 1,523 women ) without history of CVD and aged ≥ 40 years were prospect ively followed up for an average of 19 years , and the association between serum non-HDL-C levels and the incidence of type-specific CVD was estimated using a Cox proportional hazards model . CKD was defined as estimated glomerular filtration rate < 60 mL/min/1.73 m2 or proteinuria ( ≥ 1 + on dipstick ) . Results : At baseline , 357 subjects had CKD . During the follow up , 186 coronary heart disease ( CHD ) and 277 stroke events occurred . The age- and sex-adjusted incidence of CHD was significantly higher in subjects with higher non-HDL-C levels , both in those with and without CKD . In the CKD group , the risk of CHD was significantly higher in those with non-HDL-C levels of 150–189 mg/dL [ adjusted hazard ratio ( HR ) , 2.23 ; 95 % confidence interval ( CI ) , 1.04–4.77 ] and those with levels ≥ 190 mg/dL ( adjusted HR , 3.20 ; 95 % CI , 1.46–7.03 ) than in those with levels < 150 mg/dL. In the non-CKD group , the risk of CHD was significantly higher only in those with non-HDL-C levels ≥ 190 mg/dL ( adjusted HR , 2.12 ; 95 % CI , 1.33 –3.38 ) . However , no such association was observed for the risk of stroke . Conclusions : Our findings suggest that higher serum non-HDL-C levels are associated with greater risk of CHD in subjects with and without CKD and that this association is greater in subjects with CKD  than in those without CKD Background and Purpose — Several epidemiological studies have established an association between chronic kidney disease ( CKD ) , based on estimated glomerular filtration rate ( GFR ) , and risk of stroke . However , sex-specific evidence for the relationship between CKD and risk of stroke and its subtypes is still limited . Methods — We conducted a prospect i ve cohort study of 12 222 Japanese men and women age 40 to 69 years living in 4 communities under systematic surveillance of stroke incidence to determine the relationship between CKD and risk of stroke and its subtypes . Results — During the 17-year follow-up , there were 566 strokes ( 327 ischemic and 186 hemorrhagic strokes ) . GFR was inversely associated with age- and community-adjusted risk of total stroke for both men and women . Compared with the reference group without CKD ( GFR ≥60 mL/min per 1.73m2 ) , the adjusted risks of total stroke for subjects with CKD ( GFR < 60 mL/min per 1.73m2 ) were 1.63 ( 1.22–2.17 ) for men and 1.51 ( 1.13–2.02 ) for women . Excess risk of stroke associated  with CKD  was identified primarily for hemorrhagic stroke among men and for ischemic stroke among women . After adjustment for traditional cardiovascular risk factors , associations remained statistically significant . When stratified by drinking status , excess risk of hemorrhagic stroke  with CKD was confined to drinkers ; adjusted risks were 4.18 ( 2.31–7.57 ) for men and 7.00 ( 1.92–25.56 ) for women . Conclusions — CKD was associated with increased risk of hemorrhagic stroke for men , and of ischemic stroke for women . This sex difference may partly be explained by the difference in prevalence of drinkers between men and women Ambulatory blood pressure parameters , nocturnal dipping and morning surge , are associated with cardiovascular outcomes in several population s. While significant variation exists between racial groups in ambulatory blood pressure measurements and the incidence of cardiovascular disease , the effect of race on the associations of dipping and morning surge with cardiovascular outcomes is unknown . In a prospect i ve analysis of 197 African American and 197 Japanese individuals with non-diabetic chronic kidney disease matched by age and renal function , we analyzed the associations of dipping and morning surge with cardiovascular events for both races and assessed whether these relations differed by race . Higher sleep-trough morning surge  was independently associated with cardiovascular events in Japanese ( hazard ratio , 1.93 per 10 mm Hg ; 95 % confidence interval , 1.20 - 3.10 ) but not in African American participants , with race an effect modifier ( P-value < .01 ) . Dipping was not associated with cardiovascular events in either racial group . In individuals with chronic kidney disease , the association between morning surge and cardiovascular events appears to be dependent upon race , with higher morning surge a risk factors in Japanese but not in African Americans OBJECTIVES This study sought to determine the independent association of renal insufficiency with cardiovascular risk among women with known coronary heart disease ( CHD ) . BACKGROUND Although patients with end-stage renal disease and proteinuria are at high risk for cardiovascular events , little is known about the cardiovascular risk associated with moderate renal insufficiency . METHODS The Heart and Estrogen/progestin Replacement Study ( HERS ) was a clinical trial among 2,763 women with coronary disease who were r and omized to conjugated estrogen plus progestins or identical placebo and followed for a mean of 4.1 years . Women were categorized as having normal renal function ( creatinine < 1.2 mg/dl ; n = 2,012 ) , mild renal insufficiency ( 1.2 mg/dl to 1.4 mg/dl ; n = 567 ) and moderate renal insufficiency ( > 1.4 mg/dl ; n = 182 ) . We examined the independent association of renal function with incident cardiovascular events including CHD death , nonfatal myocardial infa rct ion , hospitalization for unstable angina , stroke and transient ischemic attacks . RESULTS Compared with women with normal renal function , those with mild and moderate renal insufficiency were older , more likely to be black , have a history of hypertension and diabetes and have higher serum levels of triglycerides and lipoprotein(a ) . After multivariate adjustment , both mild ( relative hazards [ RH ] = 1.24 ; 95 % confidence interval [ CI ] : 1.0 to 1.5 ) and moderate renal insufficiency ( RH = 1.57 ; 95 % CI : 1.2 to 2.1 ) were independently associated with increased risk for cardiovascular events compared with women with normal renal function . CONCLUSIONS Renal insufficiency is an independent risk factor for cardiovascular events in postmenopausal women with known coronary artery disease . Renal function may add helpful information to CHD risk stratification OBJECTIVE As little is known about the impact of non-dialysis-dependent renal dysfunction on short- and mid-term outcomes following coronary surgery we have conducted a large multi-centre study comparing patients with no history of renal dysfunction to those with preoperative renal dysfunction . METHODS Data was prospect ively collected on 19,625 consecutive patients undergoing isolated coronary surgery between 1997 and 2003 from four institutions . Sixty-seven patients had a history of dialysis support prior to coronary surgery , and were excluded from the main analysis of the study . The remaining 19,558 patients were divided into two groups based on preoperative serum creatinine level , patients with preoperative renal dysfunction with serum creatinine levels > 200 micromol/L without dialysis support and control patients with preoperative serum creatinine levels < 200 micromol/L. Case-mix was accounted for by developing a propensity score , which was the probability of belonging to the non-dialysis-dependent renal dysfunction group , and included in the multivariable analyses . RESULTS There were 19,172 patients with preoperative serum creatinine levels < 200 micromol/L and 386 patients with serum creatinine levels > 200 micromol/L without dialysis support . The propensity score included sex , body mass index , co-morbidity factors ( respiratory disease , diabetes , cerebrovascular disease , hypertension , and hypercholesterolemia ) , ejection fraction , left main stem stenosis , emergency status , prior cardiac surgery , off-pump surgery , and the logistic EuroSCORE . After adjusting for the propensity score , patients with preoperative non-dialysis-dependent renal dysfunction had significantly higher in-hospital mortality ( adjusted odds ratio 3.0 , p < 0.001 ) , stroke ( adjusted odds ratio 2.0 , p = 0.033 ) , atrial arrhythmia ( adjusted odds ratio 1.5 , p = 0.003 ) , prolonged ventilation ( adjusted odds ratio 2.1 , p < 0.001 ) , and post-op stay > 6 days ( adjusted odds ratio 2.6 , p < 0.001 ) . One thous and one hundred and eighty-three ( 6.1 % ) deaths occurred during 58,062 patient-years follow-up . After adjusting for the propensity score , the adjusted hazard ratio of mid-term mortality for non-dialysis-dependent renal dysfunction was 2.7 ( p < 0.001 ) . CONCLUSIONS Patients undergoing coronary surgery with non-dialysis-dependent renal dysfunction have significantly increased perioperative morbidity and mortality . Mid-term survival is also significantly reduced at 5-years Background Reduced glomerular filtration rate ( GFR ) is associated with increased cardiovascular risk in young and middle aged individuals . Associations with cardiovascular disease and mortality in older people are less clearly established . We aim ed to determine the predictive value of the GFR for mortality and morbidity using data from the 5,804 participants r and omized in the Prospect i ve Study of Pravastatin in the Elderly at Risk ( PROSPER ) . Methods and Findings Glomerular filtration rate was estimated ( eGFR ) using the Modification of Diet in Renal Disease equation and was categorized in the ranges ( [ 20–40 ] , [ 40–50 ] , [ 50–60 ] ) ≥ 60 ml/min/1.73 m2 . Baseline risk factors were analysed by category of eGFR , with and without adjustment for other risk factors . The associations between baseline eGFR and morbidity and mortality outcomes , accrued after an average of 3.2 y , were investigated using Cox proportional hazard models adjusting for traditional risk factors . We tested for evidence of an interaction between the benefit of statin treatment and baseline eGFR status . Age , low-density lipoprotein ( LDL ) and high-density lipoprotein ( HDL ) cholesterol , C-reactive protein ( CRP ) , body mass index , fasting glucose , female sex , histories of hypertension and vascular disease were associated with eGFR ( p = 0.001 or less ) after adjustment for other risk factors . Low eGFR was independently associated with risk of all cause mortality , vascular mortality , and other noncancer mortality and with fatal and nonfatal coronary and heart failure events ( hazard ratios adjusted for CRP and other risk factors ( 95 % confidence intervals [ CIs ] ) for eGFR < 40 ml 
    Output:
    
Conclusions - The association between chronic kidney disease and stroke appears to be highly dependent on the method of adjustment for hypertension .
The apparently independent relationship between chronic kidney disease and stroke may be confounded by their shared association with long-term prior blood pressure