University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, UK.
Section of Nephrology, Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
Nephrol Dial Transplant. 2018 Jan 1;33(1):102-112. doi: 10.1093/ndt/gfw360.
Patients on haemodialysis (HD) are at high risk for cardiovascular events, but heart failure and sudden death are more common than atherosclerotic events. The A Study to Evaluate the Use of Rosuvastatinin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA) trial was designed to assess the effect of rosuvastatin on myocardial infarction and death from any cardiac cause in 2773 HD patients. We studied predictors of the atherosclerotic cardiovascular events in AURORA.
We readjudicated all deaths and presumed myocardial infarctions according to the criteria used in the Study of Heart and Renal Protection (SHARP); these were specifically developed to separate atherosclerotic from non-atherosclerotic cardiovascular events. The readjudicated atherosclerotic end point included the first event of the following: non-fatal myocardial infarction, fatal coronary heart disease, non-fatal and fatal non-haemorrhagic stroke, coronary revascularization procedures and death from ischaemic limb disease. Stepwise Cox regression analysis was used to identify the predictors of such events.
During a mean follow-up of 3.2 years, 506 patients experienced the new composite atherosclerotic outcome. Age, male sex, prevalent diabetes, prior cardiovascular disease, weekly dialysis duration, baseline albumin [hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.94-0.99 per g/L increase], high-sensitivity C-reactive protein (HR 1.13; 95% CI 1.04-1.22 per mg/L increase) and oxidized low-density lipoprotein (LDL) cholesterol (HR 1.09; 95% CI 1.03-1.17 per 10 U/L increase) were selected as significant predictors in the model. Neither LDL cholesterol nor allocation to placebo/rosuvastatin therapy predicted the outcome.
Even with the use of strict criteria for end point definition, non-traditional risk factors, but not lipid disturbances, predicted atherosclerotic events in HD patients.
接受血液透析（HD）治疗的患者发生心血管事件的风险很高，但心力衰竭和猝死比动脉粥样硬化性事件更为常见。A 研究旨在评估在常规血液透析患者中使用瑞舒伐他汀的效果：对生存和心血管事件的评估（AURORA）试验旨在评估在 2773 例 HD 患者中，瑞舒伐他汀对心肌梗死和任何心脏原因死亡的影响。我们研究了 AURORA 中动脉粥样硬化性心血管事件的预测因素。
我们根据心脏和肾脏保护研究（SHARP）中使用的标准重新裁定了所有死亡和假定的心肌梗死；这些标准专门用于将动脉粥样硬化性和非动脉粥样硬化性心血管事件分开。重新裁定的动脉粥样硬化终点包括以下首次发生的事件：非致命性心肌梗死、致命性冠心病、非致命性和致命性非出血性中风、冠状动脉血运重建术和缺血性肢体疾病导致的死亡。逐步 Cox 回归分析用于确定这些事件的预测因素。
在平均 3.2 年的随访期间，506 例患者出现了新的复合动脉粥样硬化结局。年龄、男性、先前存在的糖尿病、先前存在的心血管疾病、每周透析时间、基线白蛋白[风险比（HR）0.96；每增加 1g/L，95%置信区间（CI）0.94-0.99]、高敏 C 反应蛋白（HR 1.13；每增加 1mg/L，95%CI 1.04-1.22）和氧化型低密度脂蛋白（LDL）胆固醇（HR 1.09；每增加 10U/L，95%CI 1.03-1.17）被选为模型中的显著预测因素。LDL 胆固醇和分配给安慰剂/瑞舒伐他汀治疗均不能预测结局。
即使使用终点定义的严格标准，非传统危险因素，但不是脂质紊乱，预测了 HD 患者的动脉粥样硬化性事件。
