Shlipak Michael G, Stehman-Breen Catherine, Vittinghoff Eric, Lin Feng, Varosy Paul D, Wenger Nanette K, Furberg Curt D
General Internal Medicine Section, Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
Am J Kidney Dis. 2004 Jan;43(1):37-44. doi: 10.1053/j.ajkd.2003.08.044.
Small changes in creatinine levels have been incrementally associated with increased risk for heart failure morbidity, but their association with cardiovascular events has not been evaluated in persons with established coronary heart disease (CHD).
This was an observational study from the Heart and Estrogen/Progestin Replacement Study (HERS) and the HERS-II follow-up study. Participants were 2,763 postmenopausal women with CHD who were followed up for a mean of 4.1 years during HERS and an additional 2.7 years during HERS-II. We evaluated the association of worsened renal function (creatinine level increase > or = 0.3 mg/dL [> or =26.5 micromol/L]) during HERS with CHD outcomes (nonfatal myocardial infarction and CHD death) that occurred during HERS-II.
Only 194 participants (9%) had worsened renal function during HERS, and they were characterized by a greater prevalence of diabetes, lower high-density lipoprotein cholesterol and higher triglyceride levels, and increased rate of cardiovascular events during HERS (all P < 0.01). After adjustment for only baseline creatinine levels, worsened renal function was associated with HERS-II CHD events (relative hazard [RH], 1.54; 95% confidence interval [CI], 1.04 to 2.29). After adjustment for baseline characteristics, HERS cardiovascular events, and medication use, worsened renal function was no longer associated with CHD events (RH, 1.08; 95% CI, 0.70 to 1.67). However, baseline creatinine levels from HERS were remarkably strong predictors of HERS-II events.
Although baseline renal function was among the strongest predictors of CHD events during 7 years of HERS follow-up, we found no significant association of worsened renal function with cardiovascular outcomes after adjustment for cardiovascular risk factors and interim events.
肌酐水平的微小变化与心力衰竭发病风险增加逐渐相关，但在已确诊冠心病（CHD）的患者中，其与心血管事件的关联尚未得到评估。
这是一项来自心脏与雌激素/孕激素替代研究（HERS）及HERS-II随访研究的观察性研究。参与者为2763名患有冠心病的绝经后女性，在HERS期间平均随访4.1年，在HERS-II期间额外随访2.7年。我们评估了HERS期间肾功能恶化（肌酐水平升高≥0.3mg/dL[≥26.5μmol/L]）与HERS-II期间发生的冠心病结局（非致命性心肌梗死和冠心病死亡）之间的关联。
在HERS期间，只有194名参与者（9%）肾功能恶化，其特点是糖尿病患病率更高、高密度脂蛋白胆固醇水平更低、甘油三酯水平更高，且HERS期间心血管事件发生率增加（所有P<0.01）。仅对基线肌酐水平进行调整后，肾功能恶化与HERS-II冠心病事件相关（相对风险[RH]，1.54；95%置信区间[CI]，1.04至2.29）。在对基线特征、HERS心血管事件和药物使用进行调整后，肾功能恶化与冠心病事件不再相关（RH，1.08；95%CI，0.70至1.67）。然而，HERS的基线肌酐水平是HERS-II事件的显著强预测指标。
尽管在HERS随访的7年中，基线肾功能是冠心病事件最强的预测指标之一，但在对心血管危险因素和中期事件进行调整后，我们发现肾功能恶化与心血管结局之间无显著关联。
