Olsen Michael H, Hansen Tine W, Christensen Marina K, Gustafsson Finn, Rasmussen Susanne, Wachtell Kristian, Ibsen Hans, Torp-Pedersen Christian, Hildebrandt Per R
Research Center for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark.
J Hypertens. 2008 Jan;26(1):26-34. doi: 10.1097/HJH.0b013e3282f18301.
Previous studies have shown that the urine albumin/creatinine ratio (UACR), high sensitivity C-reactive protein (hsCRP) and N-terminal pro brain natriuretic peptide (Nt-proBNP) predict cardiovascular events in a general population aged 41, 51, 61 or 71 years. This study investigated the impact of age and sex on their prognostic performance in a subgroup of 1994 apparently healthy individuals without diabetes, previous stroke or myocardial infarction, who did not receive any cardiovascular, antidiabetic or lipid-lowering medication.
In 1993-1994 we recorded cardiovascular risk factors, UACR, hsCRP and Nt-proBNP. The composite cardiovascular endpoint (CEP) of cardiovascular death and non-fatal stroke or myocardial infarction was assessed after 9.5 years.
In Cox regression analyses predicting CEP, the effects of log(hsCRP) and log(Nt-proBNP) were modulated by sex (P < 0.05) and age (P < 0.05), respectively. The effect of logUACR was not significantly modulated by age or sex. Log(hsCRP)/SD did not predict CEP in women, but did predict CEP in 41 plus 51-year-old men [hazard ratio (HR) 1.71; 95% confidence interval, 1.1-2.6; P < 0.05] and 61 plus 71-year-old men (HR 1.64; 1.3-2.2; P < 0.001). Log(Nt-proBNP)/SD predicted CEP in 61 plus 71-year-old women (HR 1.74; 1.2-2.5; P < 0.01) and in 61 plus 71-year-old men (HR 1.58; 1.3-2.0; P < 0.001).
Elevated hsCRP, reflecting early atherosclerosis, predicted CEP even in 41 plus 51-year-old men. Elevated Nt-proBNP, reflecting subclinical cardiovascular damage, predicted CEP in 61 plus 71-year-old subjects. Elevated UACR, reflecting endothelial dysfunction as well as microvascular damage, predicted events independently of age and sex, but primarily in 61 plus 71-year-old subjects.
既往研究表明，尿白蛋白/肌酐比值（UACR）、高敏C反应蛋白（hsCRP）和N末端脑钠肽前体（Nt-proBNP）可预测41、51、61或71岁普通人群的心血管事件。本研究调查了年龄和性别对1994名表面健康、无糖尿病、既往无中风或心肌梗死且未接受任何心血管、抗糖尿病或降脂药物治疗的亚组人群中这些指标预后性能的影响。
在1993 - 1994年，我们记录了心血管危险因素、UACR、hsCRP和Nt-proBNP。9.5年后评估心血管死亡以及非致死性中风或心肌梗死的复合心血管终点（CEP）。
在预测CEP的Cox回归分析中，log(hsCRP)和log(Nt-proBNP)的效应分别受到性别（P < 0.05）和年龄（P < 0.05）的调节。logUACR的效应未受到年龄或性别的显著调节。Log(hsCRP)/SD在女性中不能预测CEP，但在41 + 51岁男性中可预测CEP [风险比（HR）1.71；95%置信区间，1.1 - 2.6；P < 0.05]以及61 + 71岁男性中（HR 1.64；1.3 - 2.2；P < 0.001）。Log(Nt-proBNP)/SD在61 + 71岁女性中（HR 1.74；1.2 - 2.5；P < 0.01）以及61 + 71岁男性中（HR 1.58；1.3 - 2.0；P < 0.001）可预测CEP。
反映早期动脉粥样硬化的hsCRP升高，即使在41 + 51岁男性中也能预测CEP。反映亚临床心血管损伤的Nt-proBNP升高，在61 + 71岁人群中可预测CEP。反映内皮功能障碍以及微血管损伤的UACR升高，可独立于年龄和性别预测事件，但主要在61 + 71岁人群中。
