Kowey Peter R, Dickson Tania Z, Zhang Zhongxin, Shahinfar Shahnaz, Brenner Barry M
Main Line Health Heart Center, Wynnewood, Philadelphia, USA.
Clin Cardiol. 2005 Mar;28(3):136-42. doi: 10.1002/clc.4960280307.
The Reduction in ENdpoints with the Angiotensin Antagonist Losartan (RENAAL) study reported that losartan delayed the progression of renal disease in patients with type 2 diabetes and nephropathy. Diabetic or renally impaired patients are at high cardiovascular risk, a risk potentially increased in patients with both conditions.
This post hoc analysis examined whether baseline proteinuria was predictive of cardiovascular outcomes, and whether losartan modifies the risk of cardiovascular outcomes in these patients given its renal-protective effects.
The RENAAL study compared losartan with placebo (in addition to conventional antihypertensive medications) in type 2 diabetic patients with proteinuria. Morbidity and mortality due to cardiovascular causes were ascertained, and the relationship between baseline proteinuria and cardiovascular outcome was determined. The effect of treatment with losartan was examined using three time-to-event analyses of composite cardiorenal outcomes as described below.
Increasing baseline proteinuria was associated with significantly increased risk of myocardial infarction (MI) and all-cause or cardiovascular death, but not stroke. Losartan significantly reduced the risk for the combined endpoint of end-stage renal disease (ESRD), MI, stroke, or death by 21% (p < or = 0.005), irrespective of whether all-cause or cardiovascular death was included in the analysis. In addition, losartan reduced the risk for the composite of ESRD or cardiovascular death by 19.2% (p < 0.05).
In patients with type 2 diabetes and nephropathy, there is an increased risk of MI and cardiovascular or all-cause mortality. Treatment with losartan is associated with a reduction in proteinuria, a delay in the onset of ESRD, and no increased risk of cardiovascular events in this pre-ESRD population.
血管紧张素拮抗剂氯沙坦降低终点事件（RENAAL）研究报告称，氯沙坦可延缓2型糖尿病和肾病患者的肾病进展。糖尿病患者或肾功能受损患者心血管风险较高，而同时患有这两种疾病的患者风险可能更高。
这项事后分析研究了基线蛋白尿是否可预测心血管结局，以及鉴于氯沙坦的肾脏保护作用，它是否能改变这些患者的心血管结局风险。
RENAAL研究将氯沙坦与安慰剂（除传统抗高血压药物外）在有蛋白尿的2型糖尿病患者中进行了比较。确定了心血管原因导致的发病率和死亡率，并确定了基线蛋白尿与心血管结局之间的关系。使用如下所述的三种复合心肾结局的事件发生时间分析方法，研究了氯沙坦治疗的效果。
基线蛋白尿增加与心肌梗死（MI）以及全因或心血管死亡风险显著增加相关，但与中风无关。无论分析中是否包括全因或心血管死亡，氯沙坦均使终末期肾病（ESRD）、MI、中风或死亡的复合终点风险显著降低21%（p≤0.005）。此外，氯沙坦使ESRD或心血管死亡的复合风险降低了19.2%（p<0.05）。
在2型糖尿病和肾病患者中，MI以及心血管或全因死亡率的风险增加。在这个ESRD前期人群中，氯沙坦治疗与蛋白尿减少、ESRD发病延迟相关，且心血管事件风险未增加。
