Mazza Alberto, Pessina Achille C, Tikhonoff Valèrie, Montemurro Domenico, Casiglia Edoardo
Department of Clinical and Experimental Medicine, University of Padua, Padua--Italy.
J Nephrol. 2005 Sep-Oct;18(5):606-12.
Elevated serum creatinine (SCr) levels have been associated with increased mortality. Aim of this study is to evaluate whether SCr independently predicts coronary heart disease (CHD) mortality in a population of elderly with SCr values within the normal range.
Three thousand two hundred and fifty-seven men and women aged > or = 65 years were recruited in the population-based frame. Historical and clinical data, blood tests and 12-year fatal CHD events were recorded. SCr and creatinine clearance (Crcl) were divided into tertiles and, for each tertile, gender-specific adjusted relative risk (RR) with 95% confidence intervals (CI) for CHD mortality was calculated.
Both SCr and Crcl independently predicted CHD in men but not in women. In men CHD mortality increased with increasing SCr tertiles, being 1.5%, 5.5% (RR 2.51, CI 1.01-4.93) and 7.7% (RR 3.50, CI 1.41-5.88), respectively. The relationship between Crcl and CHD was inverse and increased with decreasing Crcl [2.7%, 3.3% (RR 1.42, CI 0.74-2.26) and 6.7% (RR 2.78, CI 1.56-4.12) in the 3rd, 2nd and 1st tertiles, respectively].
SCr independently predicts CHD mortality in elderly men, but not in women. The increased CHD risk observed for SCr levels within the normal range is probably due to a sub-clinical impairment of renal function.
血清肌酐（SCr）水平升高与死亡率增加相关。本研究旨在评估在血清肌酐值处于正常范围内的老年人群中，SCr是否能独立预测冠心病（CHD）死亡率。
在基于人群的框架中招募了3257名年龄≥65岁的男性和女性。记录了历史和临床数据、血液检查以及12年的冠心病致死事件。将SCr和肌酐清除率（Crcl）分为三个三分位数，并针对每个三分位数计算了冠心病死亡率的性别特异性调整相对风险（RR）及95%置信区间（CI）。
SCr和Crcl在男性中均能独立预测冠心病，但在女性中不能。在男性中，冠心病死亡率随SCr三分位数的增加而升高，分别为1.5%、5.5%（RR 2.51，CI 1.01 - 4.93）和7.7%（RR 3.50，CI 1.41 - 5.88）。Crcl与冠心病的关系呈负相关，且随着Crcl的降低而增加[在第三、第二和第一三分位数中分别为2.7%、3.3%（RR 1.42，CI 0.74 - 2.26）和6.7%（RR 2.78，CI 1.56 - 4.12）]。
SCr能独立预测老年男性的冠心病死亡率，但不能预测老年女性的。在正常范围内观察到的SCr水平导致的冠心病风险增加可能是由于肾功能的亚临床损害。
