Turkish Society of Cardiology, Istanbul, Turkey.
J Investig Med. 2013 Jan;61(1):27-33. doi: 10.2310/JIM.0b013e318276de59.
The highest levels of glomerular filtration rate are associated with increased coronary heart disease (CHD) risk, an issue we investigated in separate sexes in a population prone to metabolic syndrome.
In total, 1948 participants of the Turkish Adult Risk Factor study with available creatinine determinations were studied at a mean 3.4 years' follow-up. Using quartiles of creatinine, risk in Cox models of incident CHD or the likelihood of combined prevalent and incident CHD was assessed.
Women in the lowest creatinine quartile demonstrated the lowest risk profile across diverse variables, except showing low high-density lipoprotein cholesterol and average apolipoprotein A-I and lipoprotein (a) concentrations implicating impaired atheroprotective properties. Whereas serum creatinine in men was not significantly associated with 6 proinflammatory variables comprised in linear regression analysis, apolipoprotein A-I and lipoprotein (a) were significant positive covariates in women, the latter tending to negative association in women without metabolic syndrome. In men, the highest (>1.10 mg/dL), compared with the lowest, creatinine quartile significantly predicted CHD risk, at 1.85-fold relative risks, after adjustment for established risk factors. The risk curve in women was U-shaped, the top and bottom quartiles tending to display higher risk (odds ratio, 1.28 [95% confidence interval, 0.91-1.80]) compared with the 2 intermediate quartiles.
Increasing serum creatinine values are associated strongly and independently with CHD risk in men but not in women in whom the risk curve is U-shaped. The phenomenon of low creatinine levels underlies some hitherto unexplained relevant observations, and low measurements may be attributed to inassayability secondary to involvement in autoimmune activation.
肾小球滤过率的最高水平与冠心病（CHD）风险增加相关，我们在易患代谢综合征的人群中分别在不同性别中对此问题进行了研究。
在土耳其成人风险因素研究中，共有 1948 名参与者可获得肌酐测定值，在平均 3.4 年的随访中进行了研究。使用肌酐四分位数，在 Cox 模型中评估了 CHD 事件的风险或合并现患和新发 CHD 的可能性。
在各种变量中，最低肌酐四分位数的女性表现出最低的风险特征，但高密度脂蛋白胆固醇水平较低，平均载脂蛋白 A-I 和脂蛋白（a）浓度较低，表明其具有受损的抗动脉粥样硬化特性。而男性的血清肌酐与线性回归分析中包含的 6 个促炎变量无显著相关性，载脂蛋白 A-I 和脂蛋白（a）是女性的显著正协变量，而在没有代谢综合征的女性中，脂蛋白（a）则呈负相关趋势。在男性中，与最低肌酐四分位数相比，最高（>1.10mg/dL）的肌酐四分位数在调整了既定风险因素后，显著预测 CHD 风险，相对风险为 1.85 倍。女性的风险曲线呈 U 形，顶端和底端四分位数的风险较高（优势比，1.28 [95%置信区间，0.91-1.80]），与中间的 2 个四分位数相比。
血清肌酐值的升高与男性的 CHD 风险密切相关且独立相关，但在女性中并非如此，女性的风险曲线呈 U 形。肌酐水平低的现象说明了一些尚未解释的相关观察结果，并且低测量值可能归因于与自身免疫激活有关的检测不可用性。
