Deo Rajat, Lin Feng, Vittinghoff Eric, Tseng Zian H, Hulley Stephen B, Shlipak Michael G
Division of Cardiology, Johns Hopkins Hospital, Baltimore, Md., USA.
Hypertension. 2008 Jun;51(6):1578-82. doi: 10.1161/HYPERTENSIONAHA.107.103804. Epub 2008 Apr 7.
We evaluated the association between kidney dysfunction and sudden cardiac death risk among ambulatory women with coronary heart disease. The Heart and Estrogen Replacement Study evaluated the effects of hormone treatment on cardiovascular events among 2763 postmenopausal women with coronary heart disease. Kidney dysfunction was categorized by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation. Multivariate proportional hazards models were used to adjust for cardiovascular risk factors, congestive heart failure, and myocardial infarction. At baseline, 37% (n=1027) had an eGFR of >60 mL/min, 54% (n=1503) had an eGFR of 40 to 60 mL/min, and 8% (n=230) had an eGFR of <40 mL/min. During the 6.8-year follow-up period, there were 136 adjudicated sudden cardiac deaths. The rate of sudden cardiac death was higher in those with lower kidney function (0.5% per year among those with an eGFR >60; 0.6% per year with an eGFR between 40 and 60; and 1.7% per year with an eGFR <40 mL/min; P for trend <0.001). After multivariate analysis with baseline risk factors, eGFR at 40 to 60 mL/min was not a significant predictor, but eGFR at <40 mL/min remained strongly associated with sudden cardiac death (hazard ratio: 3.2; 95% CI: 1.9 to 5.3); adjustment for incident congestive heart failure and myocardial infarction during follow-up diminished this association (hazard ratio: 2.3; 95% CI: 1.3 to 3.9), suggesting that congestive heart failure and myocardial infarction mediated only part of the association between kidney dysfunction and sudden cardiac death. Advanced kidney dysfunction is an independent predictor of sudden cardiac death among women with coronary heart disease.
我们评估了冠心病门诊女性患者肾功能不全与心源性猝死风险之间的关联。心脏与雌激素替代研究评估了激素治疗对2763例绝经后冠心病女性心血管事件的影响。肾功能不全通过使用肾病饮食改良方程的估算肾小球滤过率(eGFR)进行分类。采用多变量比例风险模型对心血管危险因素、充血性心力衰竭和心肌梗死进行校正。在基线时,37%(n = 1027)的患者eGFR>60 mL/分钟,54%(n = 1503)的患者eGFR为40至60 mL/分钟,8%(n = 230)的患者eGFR<40 mL/分钟。在6.8年的随访期内,有136例经判定的心源性猝死。肾功能较低者的心源性猝死发生率较高(eGFR>60者每年为0.5%;eGFR在40至60之间者每年为0.6%;eGFR<40 mL/分钟者每年为1.7%;趋势P<0.001)。在对基线危险因素进行多变量分析后,eGFR在40至60 mL/分钟不是一个显著的预测因素,但eGFR<40 mL/分钟仍与心源性猝死密切相关(风险比:3.2;95%置信区间:1.9至5.3);对随访期间发生的充血性心力衰竭和心肌梗死进行校正后,这种关联减弱(风险比:2.3;95%置信区间:1.3至3.9),表明充血性心力衰竭和心肌梗死仅介导了肾功能不全与心源性猝死之间关联的一部分。晚期肾功能不全是冠心病女性心源性猝死的独立预测因素。