Edwards Matthew S, Hansen Kimberley J, Craven Timothy E, Bleyer Anthony J, Burke Gregory L, Levy Pavel J, Dean Richard H
Division of Surgical Sciences Section on Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Vasc Endovascular Surg. 2004 Jan-Feb;38(1):25-35. doi: 10.1177/153857440403800103.
Atherosclerotic renovascular disease (RVD) is a suspected contributor to the morbidity and mortality of cardiovascular disease (CVD) through its potential effects on blood pressure and excretory renal function as well as through its associations with other forms of CVD. However, population-based data regarding the associations between the presence of RVD and prevalent CVD are lacking. The Cardiovascular Health Study (CHS) is a prospective, multicenter cohort study of CVD among elderly Americans. As part of an ancillary study, participants in the Forsyth County, North Carolina, cohort of the CHS were invited to undergo renal duplex sonography (RDS) to establish the presence or absence of RVD (defined as any focal peak systolic velocity >/= 1.8 m/second or the absence of a Doppler-shifted signal from an imaged artery). Demographic, risk factor, and prevalent CVD data were obtained from the CHS coordinating center and matched with ancillary study participants. Eight hundred thirty-four CHS participants (including 525 women [63%], 309 men [37%], 194 African-Americans [23%], and 635 Caucasians [76%]) with a mean age of 77.2 +/-4.9 years underwent RDS examination. RVD was present in 57 participants (6.8%). Overall, clinical and/or subclinical manifestations of CVD were present in 603 participants (72.3%) at the time of RDS. Participants with RVD demonstrated a significantly greater prevalence of angina (p = 0.002), previous myocardial infarction (p < 0.001), >/= 25% diameter-reducing internal carotid artery stenosis (p = 0.010), increased carotid intimal medial thickness (p = 0.003), and major electrocardiographic abnormalities (p = 0.013). Following adjustment for demographics and cardiovascular risk factors, the presence of RVD demonstrated a significant and independent association with prevalent coronary artery disease but not with prevalent cerebrovascular or lower extremity vascular disease. These results suggest important population-based associations between RVD and both clinical and subclinical manifestations of CVD, especially coronary artery disease.
动脉粥样硬化性肾血管疾病（RVD）被怀疑是心血管疾病（CVD）发病和死亡的一个因素，其可能通过对血压和肾脏排泄功能的潜在影响，以及通过与其他形式的CVD的关联来发挥作用。然而，缺乏关于RVD的存在与CVD患病率之间关联的基于人群的数据。心血管健康研究（CHS）是一项针对美国老年人CVD的前瞻性、多中心队列研究。作为一项辅助研究的一部分，邀请了CHS中北卡罗来纳州福赛斯县队列的参与者接受肾脏双功超声检查（RDS），以确定是否存在RVD（定义为任何局灶性收缩期峰值速度≥1.8米/秒或成像动脉无多普勒频移信号）。人口统计学、危险因素和CVD患病率数据从CHS协调中心获取，并与辅助研究参与者进行匹配。834名CHS参与者（包括525名女性[63%]、309名男性[37%]、194名非裔美国人[23%]和635名白种人[76%]），平均年龄为77.2±4.9岁，接受了RDS检查。57名参与者（6.8%）存在RVD。总体而言，在进行RDS检查时，603名参与者（72.3%）存在CVD的临床和/或亚临床症状。患有RVD的参与者心绞痛患病率显著更高（p = 0.002）、有心肌梗死病史（p < 0.001）、颈内动脉直径缩小≥25%（p = 0.010）、颈动脉内膜中层厚度增加（p = 0.003）以及主要心电图异常（p = 0.013）。在对人口统计学和心血管危险因素进行调整后，RVD的存在与冠状动脉疾病患病率呈显著且独立的关联，但与脑血管疾病或下肢血管疾病患病率无关。这些结果表明，基于人群的RVD与CVD的临床和亚临床症状之间存在重要关联，尤其是冠状动脉疾病。
