慢性肾脏病和糖尿病对日本普通人群心血管死亡率的影响:日本国家数据库90研究的20年随访
Impacts of chronic kidney disease and diabetes on cardiovascular mortality in a general Japanese population: A 20-year follow-up of the NIPPON DATA90 study.
作者信息
Hirata Aya, Okamura Tomonori, Sugiyama Daisuke, Kuwabara Kazuyo, Kadota Aya, Fujiyoshi Akira, Miura Katsuyuki, Okuda Nagako, Ohkubo Takayoshi, Okayama Akira, Ueshima Hirotsugu
机构信息
1 Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
2 Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
出版信息
Eur J Prev Cardiol. 2017 Mar;24(5):505-513. doi: 10.1177/2047487316679904. Epub 2016 Nov 19.
Background Studies have shown significant associations of chronic kidney disease (CKD) and diabetes mellitus (DM) with cardiovascular disease (CVD) mortality. The impact on the general population is an important public health issue. However, the population attributable fraction (PAF) of CVD because of CKD and/or DM in a general population is uncertain. Methods We followed 7229 participants (age: ≥30 years) with no history of CVD in a Japanese community. We divided participants into four categories according to CKD and/or DM and calculated hazard ratios (HRs) of CVD mortality for each category using a Cox proportional hazards model adjusted for age, dyslipidemia, smoking and alcohol consumption. In addition, PAFs of CVD were estimated among populations with CKD and/or DM. Results During 20-year follow-up, 488 participants died. HRs for CVD were 1.63 [95% confidence interval (CI): 1.16-2.30] with DM only, 1.42 (95% CI: 1.08-1.86) with CKD only and 2.37 (95% CI: 1.40-4.01) with CKD + DM. In men, the corresponding HRs for CVD were 1.88 (95% CI: 1.19-2.97), 1.71 (95% CI: 1.15-2.56) and 3.26 (95% CI: 1.69-6.30), respectively; the corresponding PAFs of CVD were 4.1%, 5.1% and 2.9%, respectively. PAFs for CVD among women were lower than those in men, 1.6% for DM only, 2.0% for CKD only and 0.7% for CKD + DM. Conclusions PAFs of CVD mortality due to CKD and/or DM were not so high in past 20 years; however, they might increase in the future because of recent increase in prevalence of these in Japanese population.
背景 研究表明,慢性肾脏病(CKD)和糖尿病(DM)与心血管疾病(CVD)死亡率之间存在显著关联。这对普通人群的影响是一个重要的公共卫生问题。然而,普通人群中因CKD和/或DM导致的CVD人群归因分数(PAF)尚不确定。方法 我们对日本一个社区中7229名无CVD病史的参与者(年龄:≥30岁)进行了随访。我们根据CKD和/或DM将参与者分为四类,并使用校正了年龄、血脂异常、吸烟和饮酒情况的Cox比例风险模型计算每类人群CVD死亡的风险比(HR)。此外,我们还估计了CKD和/或DM人群中CVD的PAF。结果 在20年的随访期间,488名参与者死亡。仅患有DM的人群CVD的HR为1.63[95%置信区间(CI):1.16 - 2.30],仅患有CKD的人群为1.42(95%CI:1.08 - 1.86),患有CKD + DM的人群为2.37(95%CI:1.40 - 4.01)。在男性中,CVD的相应HR分别为1.88(95%CI:1.19 - 2.97)、1.71(95%CI:1.15 - 2.56)和3.26(95%CI:1.69 - 6.30);CVD的相应PAF分别为4.1%、5.1%和2.9%。女性中CVD的PAF低于男性,仅患有DM的为1.6%,仅患有CKD的为2.0%,患有CKD + DM的为0.7%。结论 在过去20年中,因CKD和/或DM导致的CVD死亡的PAF并不高;然而,由于这些疾病在日本人群中的患病率近期有所上升,未来它们可能会增加。