Trespalacios Fernando C, Taylor Allen J, Agodoa Lawrence Y, Abbott Kevin C
Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA.
Kidney Int. 2002 Nov;62(5):1799-805. doi: 10.1046/j.1523-1755.2002.00638.x.
Patients on dialysis have a disproportionately high rate of cardiovascular disease (CVD). However, the incidence and risk factors for incident acute coronary syndromes (ACS) have not been previously assessed in dialysis patients.
We analyzed the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study (DMMS) Wave II in a historical cohort study of ACS. Data from 3374 patients who started dialysis in 1996 with valid follow-up times were available for analysis, censored at the time of renal transplantation and followed until March 2000. Cox regression analysis was used to model factors associated with time to first hospitalization for ACS (ICD9 code 410.x or 411.x) adjusted for comorbidities, demographic factors, baseline laboratory values, blood pressures and cholesterol levels, type of vascular access, dialysis adequacy, and cardioprotective medications (angiotensin-converting enzyme inhibitors, calcium channel blockers, HMG-CoA reductase inhibitors (statins), beta blockers, and aspirin). Follow-up was 2.19 +/- 1.14 years.
The incidence of ACS was 29/1000 person-years. Factors associated with ACS were older age, the extreme high and low ranges of serum cholesterol level, history of coronary heart disease (CHD), male gender, and diabetes. No cardioprotective medications including statins had a significant association with ACS in this study. However, medications known to reduce mortality after ACS were used in less than 50% of patients with known CHD at the start of the study, and statins were used in less than 10% of patients with CHD.
Dialysis patients had similar risk factors for ACS compared to the general population. Cardioprotective medications were not associated with a significant benefit, possibly due to their striking underutilization in this at-risk population.
透析患者心血管疾病（CVD）发生率异常高。然而，既往尚未评估透析患者新发急性冠脉综合征（ACS）的发病率及危险因素。
我们在一项关于ACS的历史性队列研究中分析了美国肾脏数据系统（USRDS）透析发病率和死亡率研究（DMMS）第二波数据。对1996年开始透析且有有效随访时间的3374例患者的数据进行分析，在肾移植时进行截尾，并随访至2000年3月。采用Cox回归分析对与首次因ACS住院时间（国际疾病分类第九版代码410.x或411.x）相关的因素进行建模，这些因素已根据合并症、人口统计学因素、基线实验室值、血压和胆固醇水平、血管通路类型、透析充分性以及心脏保护药物（血管紧张素转换酶抑制剂、钙通道阻滞剂、HMG-CoA还原酶抑制剂（他汀类药物）、β受体阻滞剂和阿司匹林）进行了调整。随访时间为2.19±1.14年。
ACS的发病率为29/1000人年。与ACS相关的因素包括年龄较大、血清胆固醇水平的极高和极低范围、冠心病（CHD）病史、男性性别和糖尿病。在本研究中，包括他汀类药物在内的心脏保护药物与ACS均无显著关联。然而，在研究开始时，已知可降低ACS后死亡率的药物在已知CHD的患者中使用比例不到50%，他汀类药物在CHD患者中的使用比例不到10%。
与普通人群相比，透析患者发生ACS的危险因素相似。心脏保护药物未显示出显著益处，可能是由于其在这一高危人群中的使用严重不足。
