Wattanakit Keattiyoat, Coresh Josef, Muntner Paul, Marsh Jane, Folsom Aaron R
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454-1015, USA.
J Am Coll Cardiol. 2006 Sep 19;48(6):1183-9. doi: 10.1016/j.jacc.2006.05.047. Epub 2006 Aug 28.
This study sought to determine whether chronic kidney disease (CKD) should be considered a coronary heart disease (CHD) risk equivalent for cholesterol treatment.
It is unclear whether patients with CKD have a risk of CHD events or cardiovascular disease (CVD) mortality equivalent to patients with a prior myocardial infarction (MI).
Using data from the ARIC (Atherosclerosis Risk in Communities) study, we categorized nondiabetic participants based on their average level of kidney function (estimated glomerular filtration rate > or =60 or 30 to 59 ml/min/1.73 m2, which defines stage 3 CKD) and on prior MI (yes or no). Rates and relative risks (RR) of CHD (MI or fatal CHD) events (n = 653) and CVD mortality (n = 209) that occurred over 10 years were compared across these populations.
Among 12,243 middle-age participants, 271 had stage 3 CKD. After adjustment for age, gender, race, and center, CHD incidence and CVD mortality rates per 1,000 person-years by presence of CKD and MI were 4.1 and 1.0 in the presence of neither condition, 8.0 and 3.4 in CKD only, 18.8 and 7.0 in MI only, and 30.8 and 18.0 in CKD and MI. After further adjustment for CVD risk factors, RR of CHD and CVD mortality were statistically significantly lower in subjects with CKD and no prior MI (RR = 0.44 [95% confidence interval (CI) 0.28 to 0.72] for CHD and RR = 0.46 [95% CI 0.24 to 0.90] for CVD mortality) than for subjects with no CKD and a prior MI.
Stage 3 CKD confers CHD risk that is lower and not equivalent to a prior MI in this middle-aged, general, nondiabetic population.
本研究旨在确定慢性肾脏病（CKD）是否应被视为等同于冠心病（CHD）风险，从而进行胆固醇治疗。
目前尚不清楚CKD患者发生CHD事件或心血管疾病（CVD）死亡的风险是否等同于既往有心肌梗死（MI）的患者。
利用社区动脉粥样硬化风险（ARIC）研究的数据，我们根据非糖尿病参与者的平均肾功能水平（估计肾小球滤过率>或=60或30至59 ml/min/1.73 m2，这定义为3期CKD）以及既往MI情况（是或否）进行分类。比较了这些人群中10年内发生的CHD（MI或致命性CHD）事件（n = 653）和CVD死亡（n = 209）的发生率及相对风险（RR）。
在12243名中年参与者中，271人患有3期CKD。在调整年龄、性别、种族和中心因素后，每1000人年中，无CKD和MI的人群中CHD发病率和CVD死亡率分别为4.1和1.0，仅患有CKD的人群中分别为8.0和3.4，仅患有MI的人群中分别为18.8和7.0，同时患有CKD和MI的人群中分别为30.8和18.0。在进一步调整CVD危险因素后，无既往MI的CKD患者发生CHD和CVD死亡的RR在统计学上显著低于无CKD且有既往MI的患者（CHD的RR = 0.44 [95%置信区间（CI）0.28至0.72]，CVD死亡的RR = 0.46 [95%CI 0.24至0.90]）。
在这个中年、普通、非糖尿病人群中，3期CKD所带来的CHD风险较低，且不等同于既往MI。
