Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein, Liechtenstein.
Atherosclerosis. 2010 Jul;211(1):348-52. doi: 10.1016/j.atherosclerosis.2010.02.031. Epub 2010 Mar 1.
Impaired kidney function is associated with cardiovascular disease. However, from the available data it cannot be discerned which of the two entities presents first and entails the other. If renal dysfunction is first, a dynamic decline in the estimated glomerular filtration rate (eGFR) should predict vascular events and prove a useful biomarker for atherothrombotic disease. We therefore tested the hypothesis that a decrease in kidney function predicts future vascular events in a high-risk population of angiographically characterized coronary patients.
We calculated the eGFR by the Mayo clinic quadratic equation at baseline and after two years in a high-risk population of 400 consecutive men undergoing coronary angiography, of whom 355 had coronary artery disease (CAD). Vascular events were recorded over six years.
A serial decrease in kidney function from baseline to the follow-up visit two years later significantly predicted vascular events in the subsequent four years independently from the baseline eGFR with a standardized adjusted hazard ratio (HR) of 1.41 (1.13-1.76); p=0.003. This result proved robust after adjustment for age, BMI, hypertension, diabetes, LDL-C, HDL-C, smoking, and high-sensitivity C-reactive protein (HR=1.41 [1.12-1.78]; p=0.004). The predictive power of eGFR loss was confirmed even after further adjustment for the presence of CAD at baseline (HR=1.43 [1.12-1.81]; p=0.004). In this fully adjusted model a 10 ml/min/1.73 m2 decrease in eGFR independently conferred a 31% increase in cardiovascular event risk (p=0.004).
A decline of eGFR over two years strongly, significantly, and independently predicts vascular events over the subsequent four years. Declining eGFR is a readily obtainable and inexpensive candidate new biomarker for the progression of atherothrombotic disease.
肾功能受损与心血管疾病相关。然而，根据现有数据，尚无法确定这两种情况哪个先出现并导致另一种情况。如果肾功能障碍先出现，估算肾小球滤过率（eGFR）的动态下降应该可以预测血管事件，并成为动脉粥样血栓疾病的有用生物标志物。因此，我们检验了这样一个假设，即肾功能下降可以预测血管事件，这一假设在经过血管造影特征性冠状动脉检查的高风险人群中得到了验证。
我们通过 Mayo 诊所二次方程计算了 400 例连续接受冠状动脉造影的高危人群的基线和两年后的 eGFR，其中 355 例患有冠状动脉疾病（CAD）。在六年期间记录了血管事件。
从基线到两年后的随访，肾功能的连续下降显著预测了随后四年的血管事件，这与基线 eGFR 独立相关，标准化调整后的危险比（HR）为 1.41（1.13-1.76）；p=0.003。在调整年龄、BMI、高血压、糖尿病、LDL-C、HDL-C、吸烟和高敏 C 反应蛋白（HR=1.41[1.12-1.78]；p=0.004）后，这一结果仍然稳健。即使在进一步调整基线 CAD 存在的情况下，eGFR 下降的预测能力也得到了证实（HR=1.43[1.12-1.81]；p=0.004）。在这个完全调整的模型中，eGFR 下降 10 ml/min/1.73 m2 可使心血管事件风险增加 31%（p=0.004）。
在两年内 eGFR 的下降强烈、显著且独立地预测了随后四年的血管事件。eGFR 的下降是动脉粥样血栓疾病进展的一个易于获得且经济实惠的新型生物标志物候选物。
