心血管危险因素治疗目标与高危血管患者的肾脏并发症：一项队列研究。

Cardiovascular risk factor treatment targets and renal complications in high risk vascular patients: a cohort study.

机构信息

Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.

出版信息

BMC Cardiovasc Disord. 2011 Jul 5;11:40. doi: 10.1186/1471-2261-11-40.

DOI:10.1186/1471-2261-11-40

PMID:21729268

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3141761/

Abstract

BACKGROUND

To determine if recommended treatment targets, as specified in clinical practice guidelines for the management of cardiovascular disease, reduces the risk of renal complications in high risk patient populations.

METHODS

This was a cohort study. Participants in Utrecht, The Netherlands either at risk of, or had cardiovascular disease were recruited. Cardiovascular treatment targets were achievement of control in systolic and diastolic blood pressure, total and low-density cholesterol, and treatment of albuminuria. Outcome measures were time to development of end stage renal failure or symptomatic renal atherosclerotic disease requiring intervention.

RESULTS

The cohort consisted of 7,208 participants; 1,759 diabetics and 4,859 with clinically manifest vascular disease. The median age was 57 years and 67% were male. Overall, 29% of the cohort achieved the treatment target for systolic blood pressure, 39% for diastolic blood pressure, 28% for total cholesterol, 31% for LDL cholesterol and 78% for albuminuria. The incidence rate for end stage renal failure and renal atherosclerotic disease reduced linearly with each additional treatment target achieved (p value less than 0.001). Achievement of any two treatment targets reduced the risk of renal complications, hazard ratio 0.46 (95% CI 0.26-0.82). For patients with clinically manifest vascular disease and diabetes, the hazard ratios were 0.56 (95% CI 0.28 - 1.12) and 0.28 (95%CI 0.10 - 0.79) respectively.

CONCLUSION

Clinical guidelines for cardiovascular disease management do reduce risk of renal complications in high risk patients. Benefits are seen with attainment of any two treatment targets.

摘要

背景

确定心血管疾病管理临床实践指南中推荐的治疗目标是否降低高危患者人群发生肾脏并发症的风险。

方法

这是一项队列研究。参与者来自荷兰乌得勒支，有发生心血管疾病的风险或已患有心血管疾病。心血管治疗目标是控制收缩压和舒张压、总胆固醇和低密度脂蛋白胆固醇，并治疗白蛋白尿。结局指标为进展至终末期肾衰竭或需要干预的有症状肾动脉粥样硬化疾病的时间。

结果

队列包括 7208 名参与者；1759 名糖尿病患者和 4859 名有临床显性血管疾病患者。中位年龄为 57 岁，67%为男性。总体而言，29%的患者达到收缩压治疗目标，39%达到舒张压治疗目标，28%达到总胆固醇治疗目标，31%达到 LDL 胆固醇治疗目标，78%达到白蛋白尿治疗目标。终末期肾衰竭和肾动脉粥样硬化疾病的发生率随每个额外治疗目标的实现而呈线性下降（p 值小于 0.001）。达到两个以上治疗目标可降低肾脏并发症的风险，风险比为 0.46（95%置信区间为 0.26-0.82）。对于有临床显性血管疾病和糖尿病的患者，风险比分别为 0.56（95%置信区间为 0.28-1.12）和 0.28（95%置信区间为 0.10-0.79）。