Kasiske Bertram L, Chakkera Harini A, Roel Joseph
Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
J Am Soc Nephrol. 2000 Sep;11(9):1735-1743. doi: 10.1681/ASN.V1191735.
Whether the high incidence of ischemic heart disease (IHD) among renal transplant patients can be attributed to the same risk factors that have been identified in the general population is unclear. The risk for major IHD events occurring >1 yr after transplantation among 1124 transplant recipients was estimated by using the risk calculated from the Framingham Heart Study (FHS). The FHS risk predicted IHD (relative risk, 1.28; 95% confidence interval, 1.20 to 1.40; P: < 0.001); however, the FHS risk tended to underestimate the risk of IHD for renal transplant recipients. This was largely attributable to increased risks associated with diabetes mellitus and, to a lesser extent, age and cigarette smoking for renal transplant recipients. For men, the relative risks for diabetes mellitus were 2.78 (1.73 to 4.49) and 1.53 for the transplant recipient and FHS populations, respectively; the relative risks for age (in years) were 1.06 (1.04 to 1.08) and 1.05, respectively, and those for smoking were 1.95 (1.20 to 3.19) and 1.69, respectively. For women, the relative risks for diabetes mellitus were 5.40 (2.73 to 10.66) and 1.82, respectively. There was a tendency for the risk associated with cholesterol levels to be higher for transplant recipients, compared with the FHS population, but the risks associated with high-density lipoprotein cholesterol levels and BP appeared to be comparable. Independent of these and other risk factors, the adjusted risk of IHD for the transplant recipient population has decreased. Compared with the era before 1986, transplantation between 1986 and 1992 was associated with a lower relative risk of 0.60 (0.39 to 0.92); transplantation after 1992 was associated with an even lower relative risk of 0.27 (0.11 to 0.63) for IHD. Of concern was the fact that dihydropyridine calcium channel antagonists were associated with an increased risk for IHD (relative risk, 2.26; 95% confidence interval, 1.24 to 4.12; P: = 0. 008), and this association was independent of other antihypertensive agents and risk factors. Therefore, although the FHS risk predicts IHD after renal transplantation, it tends to underestimate the risks, especially the risk associated with diabetes mellitus. The unexpected finding that dihydropyridine calcium channel antagonists were associated with an increased IHD risk merits further evaluation.
肾移植患者中缺血性心脏病（IHD）的高发病率是否可归因于在普通人群中已确定的相同风险因素尚不清楚。通过使用从弗雷明汉心脏研究（FHS）计算出的风险，对1124名移植受者移植后>1年发生主要IHD事件的风险进行了估计。FHS风险预测了IHD（相对风险，1.28；95%置信区间，1.20至1.40；P：<0.001）；然而，FHS风险往往低估了肾移植受者的IHD风险。这在很大程度上归因于糖尿病相关风险的增加，以及在较小程度上归因于肾移植受者的年龄和吸烟。对于男性，移植受者和FHS人群中糖尿病的相对风险分别为2.78（1.73至4.49）和1.53；年龄（岁）的相对风险分别为1.06（1.04至1.08）和1.05，吸烟的相对风险分别为1.95（1.20至3.19）和1.69。对于女性，糖尿病的相对风险分别为5.40（2.73至10.66）和1.82。与FHS人群相比，移植受者中与胆固醇水平相关的风险有升高的趋势，但与高密度脂蛋白胆固醇水平和血压相关的风险似乎相当。独立于这些及其他风险因素，移植受者人群中IHD的调整后风险有所降低。与1986年以前的时代相比，1986年至1992年期间的移植与较低的相对风险0.60（0.39至0.92）相关；1992年以后的移植与IHD的相对风险更低，为0.27（0.11至0.63）。令人担忧的是，二氢吡啶类钙通道拮抗剂与IHD风险增加相关（相对风险，2.26；95%置信区间，1.24至4.12；P：=0.008），且这种关联独立于其他抗高血压药物和风险因素。因此，尽管FHS风险可预测肾移植后的IHD，但它往往低估了风险，尤其是与糖尿病相关的风险。二氢吡啶类钙通道拮抗剂与IHD风险增加相关这一意外发现值得进一步评估。
