27年随访期间蛋白尿与中风及冠心病风险：檀香山心脏项目

Proteinuria and risk for stroke and coronary heart disease during 27 years of follow-up: the Honolulu Heart Program.

作者信息

Madison James R, Spies Christian, Schatz Irwin J, Masaki Kamal, Chen Randi, Yano Katsuhiko, Curb J David

机构信息

Department of Internal Medicine, University of Hawaii, John A. Burns School of Medicine, Honolulu, USA.

出版信息

Arch Intern Med. 2006 Apr 24;166(8):884-9. doi: 10.1001/archinte.166.8.884.

DOI:10.1001/archinte.166.8.884

PMID:16636214

Abstract

BACKGROUND

Urinary protein excretion has been linked to coronary heart disease (CHD); the relationship to stroke is less clear. We assessed whether urine dipstick screening for protein predicted stroke and CHD in the Honolulu Heart Program cohort.

METHODS

Prospective, observational study of 6252 Japanese American men in Honolulu aged 45 to 68 years. Proteinuria was detected by means of urine dipstick screening during the first and third examinations. Subjects were classified as having no proteinuria if results were negative at both examinations, transient proteinuria if results were positive at 1 examination, and persistent proteinuria if results were positive at both examinations. Relative risk was derived using those subjects with no proteinuria as the reference. Outcomes were assessed through 27 years.

RESULTS

No proteinuria was found in 92.8% of subjects, transient proteinuria in 6.1%, and persistent proteinuria in 1.1%. The age-adjusted incident stroke rates were 3.7, 7.3, and 11.8 per 1000 person-years in subjects with no, transient, or persistent proteinuria, respectively (P<.001). Age-adjusted rates of incident CHD were 9.4, 15.8, and 35.2 events per 1000 person-years, respectively (P<.001). Using Cox proportional hazards models, adjusting for age, body mass index, physical activity, smoking status, cholesterol level, presence of hypertension or diabetes mellitus, and alcohol consumption, the relative risk for 27-year incident stroke was 1.66 (95% confidence interval, 1.21-2.30; P = .002) with transient proteinuria and 2.84 (95% confidence interval, 1.51-5.34; P = .001) with persistent proteinuria, and relative risk for 27-year incident CHD was 1.48 (95% confidence interval, 1.19-1.83; P<.001) with transient proteinuria and 3.72 (95% confidence interval, 2.62-5.27; P<.001) with persistent proteinuria.

CONCLUSION

Proteinuria detected at urine dipstick screening independently predicted increased risk for incident stroke and incident CHD over 27 years in this cohort.

摘要

背景

尿蛋白排泄与冠心病（CHD）有关；与中风的关系尚不清楚。我们评估了在檀香山心脏项目队列中，通过尿试纸筛查蛋白质是否能预测中风和冠心病。

方法

对檀香山6252名年龄在45至68岁之间的日裔美国男性进行前瞻性观察研究。在第一次和第三次检查期间，通过尿试纸筛查检测蛋白尿。如果两次检查结果均为阴性，则受试者被分类为无蛋白尿；如果一次检查结果为阳性，则为短暂性蛋白尿；如果两次检查结果均为阳性，则为持续性蛋白尿。以无蛋白尿的受试者为参照计算相对风险。随访27年评估结局。

结果

92.8%的受试者无蛋白尿，6.1%有短暂性蛋白尿，1.1%有持续性蛋白尿。无、短暂性或持续性蛋白尿的受试者年龄调整后的中风发病率分别为每1000人年3.7、7.3和11.8例（P<0.001）。年龄调整后的冠心病发病率分别为每1000人年9.4、15.8和35.2例（P<0.001）。使用Cox比例风险模型，对年龄、体重指数、身体活动、吸烟状况、胆固醇水平、高血压或糖尿病的存在以及饮酒情况进行调整后，短暂性蛋白尿27年中风发病的相对风险为1.66（95%置信区间，1.21 - 2.30；P = 0.002），持续性蛋白尿为2.84（95%置信区间，1.51 - 5.34；P = 0.001）；短暂性蛋白尿27年冠心病发病的相对风险为1.48（95%置信区间，1.19 - 1.83；P<0.001），持续性蛋白尿为3.72（95%置信区间，2.62 - 5.27；P<0.001）。