Deo Rajat, Fyr Christina L Wassel, Fried Linda F, Newman Anne B, Harris Tamara B, Angleman Sara, Green Christie, Kritchevsky Stephen B, Chertow Glenn M, Cummings Steven R, Shlipak Michael G
Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA.
Am Heart J. 2008 Jan;155(1):62-8. doi: 10.1016/j.ahj.2007.08.012. Epub 2007 Oct 24.
Impaired kidney function has been associated with increased risk for death, myocardial infarction, stroke, and heart failure in high-risk populations. We evaluated whether impaired kidney function predicted risk of fatal cardiovascular disease independent of prevalent and incident cardiovascular events.
The Health, Aging, and Body Composition study is a cohort of well-functioning, elderly participants aged 70 to 79 years at entry. We measured serum cystatin C and creatinine from baseline plasma samples of 3044 participants and followed them over 6 years, examining the associations among kidney function, cardiovascular death, and incident cardiovascular events. Cystatin C was categorized as low (< 0.84 mg/L), medium (0.84-1.18 mg/L), or high (> or = 1.19 mg/L); serum creatinine (cutoff value of > or = 1.3 in women and > or = 1.5 in men) and estimated glomerular filtration rate (eGFR; greater and less than 60 mL/min per 1.73 m2) were dichotomized.
During follow-up, 242 cardiovascular deaths occurred, of which 69 were in participants without prior cardiovascular events; 294 incident cardiovascular events occurred including 135 myocardial infarctions and 163 strokes. Higher cystatin C concentrations were significantly associated with cardiovascular death (adjusted hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.05-2.76 for the medium cystatin C group; and HR 2.24, 95% CI 1.30-3.86 for the high cystatin C group, relative to the low cystatin C group). The point estimate was of greater magnitude in the analysis that excluded prevalent cardiovascular disease (adjusted HR 2.68, 95% CI 0.94-7.70 for the medium cystatin C group; and HR 4.91, 95% CI, 1.55-15.54 for the high cystatin C group). Elevated creatinine levels (adjusted HR 1.54, 95% CI 1.02-2.33, and HR 2.28, 95% CI 1.10-4.73 among participants without a history of cardiovascular disease) were also associated with cardiovascular death. No significant association was found between low eGFR and cardiovascular death. In addition, cystatin C, low eGFR, or elevated creatinine levels were not associated with other cardiovascular events.
Impaired kidney function is a strong predictor of cardiovascular death, particularly among participants without prior history of cardiovascular disease.
在高危人群中，肾功能受损与死亡、心肌梗死、中风及心力衰竭风险增加相关。我们评估了肾功能受损是否能独立于既往及新发心血管事件预测致命性心血管疾病风险。
健康、衰老与身体成分研究是一个队列研究，入组时参与者为70至79岁、功能良好的老年人。我们从3044名参与者的基线血浆样本中检测了血清胱抑素C和肌酐，并对他们进行了6年的随访，研究肾功能、心血管死亡及新发心血管事件之间的关联。胱抑素C分为低（<0.84mg/L）、中（0.84 - 1.18mg/L）、高（≥1.19mg/L）三组；血清肌酐（女性临界值≥1.3，男性临界值≥1.5）和估算肾小球滤过率（eGFR；每1.73m²大于或小于60mL/min）进行二分法分类。
随访期间，发生了242例心血管死亡，其中69例发生在无既往心血管事件的参与者中；发生了294例新发心血管事件，包括135例心肌梗死和163例中风。较高的胱抑素C浓度与心血管死亡显著相关（中胱抑素C组调整后风险比[HR]1.70，95%置信区间[CI]1.05 - 2.76；高胱抑素C组HR 2.24，95%CI 1.30 - 3.86，相对于低胱抑素C组）。在排除既往心血管疾病的分析中，点估计值更大（中胱抑素C组调整后HR 2.68，95%CI 0.94 - 7.70；高胱抑素C组HR 4.91，95%CI 1.55 - 15.54）。肌酐水平升高（无心血管疾病病史参与者中调整后HR 1.54，95%CI 1.02 - 2.33，HR 2.28，95%CI 1.10 - 4.73）也与心血管死亡相关。低eGFR与心血管死亡之间未发现显著关联。此外，胱抑素C、低eGFR或肌酐水平升高与其他心血管事件无关。
肾功能受损是心血管死亡的有力预测指标，尤其是在无心血管疾病既往史的参与者中。
