Rubin Clifford, Nolin Thomas D, Himmelfarb Jonathan
Division of Nephrology and Transplantation, Department of Medicine, Maine Medical Center, Portland, Maine 04102, USA.
Curr Opin Nephrol Hypertens. 2007 Nov;16(6):506-11. doi: 10.1097/MNH.0b013e3282f0b331.
Chronic kidney disease is now recognized as an independent risk factor for cardiovascular events, and cardiovascular disease is the major cause of mortality in patients with the disease. Recent studies have attempted to evaluate the utility of biomarkers for assessing cardiovascular risk in patients with chronic kidney disease. This review will summarize these studies and critically assess the utility of cardiovascular risk biomarkers for clinical practice.
Traditional cardiovascular risk factors including dyslipidemia, hypertension, smoking and diabetes mellitus are highly prevalent in patients with chronic kidney disease. Although prediction models using traditional risk factors underestimate cardiovascular disease risk in these patients, nontraditional biomarkers (i.e. markers of inflammation, endothelial dysfunction, myocardial necrosis, and left ventricular remodeling) have been associated with increased cardiovascular event rates and mortality risk in populations with and without chronic kidney disease. Moreover, a high prevalence of biomarkers that are directly attributable to loss of kidney function is observed in patients with the disease.
Recent studies suggest only limited utility of either single or multiple biomarkers of cardiovascular risk as prognostic tools in patients with and without chronic kidney disease. Novel approaches for biomarker development capturing augmented information through a systems biology approach are urgently needed to improve the usefulness of cardiovascular risk biomarkers.
慢性肾脏病现已被公认为心血管事件的独立危险因素，而心血管疾病是该疾病患者死亡的主要原因。近期研究试图评估生物标志物在评估慢性肾脏病患者心血管风险中的作用。本综述将总结这些研究，并严格评估心血管风险生物标志物在临床实践中的作用。
包括血脂异常、高血压、吸烟和糖尿病在内的传统心血管危险因素在慢性肾脏病患者中高度流行。尽管使用传统危险因素的预测模型低估了这些患者的心血管疾病风险，但非传统生物标志物（即炎症、内皮功能障碍、心肌坏死和左心室重构标志物）在有或无慢性肾脏病的人群中均与心血管事件发生率和死亡风险增加相关。此外，在该疾病患者中观察到直接归因于肾功能丧失的生物标志物的高患病率。
近期研究表明，无论是单一还是多种心血管风险生物标志物，作为有或无慢性肾脏病患者的预后工具，其作用都很有限。迫切需要通过系统生物学方法开发能够获取更多信息的新型生物标志物，以提高心血管风险生物标志物的实用性。
