Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana2Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
LA BioMed at Harbor-UCLA Medical Center, Los Angeles, California.
JAMA Cardiol. 2017 Jun 1;2(6):635-643. doi: 10.1001/jamacardio.2017.0363.
Coronary artery calcification (CAC) is highly prevalent in dialysis-naive patients with chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease and all-cause mortality in this population.
To study the prospective association of CAC with risk of cardiovascular disease and all-cause mortality among dialysis-naive patients with CKD.
DESIGN, SETTING, AND PARTICIPANTS: The prospective Chronic Renal Insufficiency Cohort study recruited adults with an estimated glomerular filtration rate of 20 to 70 mL/min/1.73 m2 from 7 clinical centers in the United States. There were 1541 participants without cardiovascular disease at baseline who had CAC scores.
Coronary artery calcification was assessed using electron-beam or multidetector computed tomography.
Incidence of cardiovascular disease (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every 6 months and confirmed by medical record adjudication.
During an average follow-up of 5.9 years in 1541 participants aged 21 to 74 years, there were 188 cardiovascular disease events (60 cases of myocardial infarction, 120 heart failures, and 27 strokes; patients may have had >1 event) and 137 all-cause deaths. In Cox proportional hazards models adjusted for age, sex, race, clinical site, education level, physical activity, total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, use of antihypertensive treatment, current cigarette smoking, diabetes status, body mass index, C-reactive protein level, hemoglobin A1c level, phosphorus level, troponin T level, log N-terminal pro-B-type natriuretic peptide level, fibroblast growth factor 23 level, estimated glomerular filtration rate, and proteinuria, the hazard ratios associated with per 1 SD log of CAC were 1.40 (95% CI, 1.16-1.69; P < .001) for cardiovascular disease, 1.44 (95% CI, 1.02-2.02; P = .04) for myocardial infarction, 1.39 (95% CI, 1.10-1.76; P = .006) for heart failure, and 1.19 (95% CI, 0.94-1.51; P = .15) for all-cause mortality. In addition, inclusion of CAC score led to an increase in the C statistic of 0.02 (95% CI, 0-0.09; P < .001) for predicting cardiovascular disease over use of all the above-mentioned established and novel cardiovascular disease risk factors.
Coronary artery calcification is independently and significantly related to the risks of cardiovascular disease, myocardial infarction, and heart failure in patients with CKD. In addition, CAC improves risk prediction for cardiovascular disease, myocardial infarction, and heart failure over use of established and novel cardiovascular disease risk factors among patients with CKD; however, the changes in the C statistic are small.
在慢性肾脏病 (CKD) 透析前患者中，冠状动脉钙化 (CAC) 非常普遍。然而，关于 CAC 与该人群心血管疾病和全因死亡率的后续风险之间的关联，数据仍然很少。
研究 CAC 与透析前 CKD 患者心血管疾病和全因死亡率风险的前瞻性关联。
设计、地点和参与者：前瞻性慢性肾功能不全队列研究从美国 7 个临床中心招募了估计肾小球滤过率在 20 至 70 mL/min/1.73 m2 之间的成年人。基线时没有心血管疾病的 1541 名参与者具有 CAC 评分。
使用电子束或多排 CT 评估冠状动脉钙化。
心血管疾病（包括心肌梗死、心力衰竭和中风）和全因死亡率的发生率每 6 个月报告一次，并通过病历审查确认。
在 1541 名年龄在 21 至 74 岁的参与者中，平均随访 5.9 年后，发生了 188 例心血管疾病事件（60 例心肌梗死、120 例心力衰竭和 27 例中风；患者可能有>1 例事件）和 137 例全因死亡。在调整年龄、性别、种族、临床地点、教育水平、体力活动、总胆固醇水平、高密度脂蛋白胆固醇水平、收缩压、使用降压治疗、当前吸烟状况、糖尿病状况、体重指数、C 反应蛋白水平、糖化血红蛋白水平、磷水平、肌钙蛋白 T 水平、N 末端 pro-B 型利钠肽水平、成纤维细胞生长因子 23 水平、估计肾小球滤过率和蛋白尿的 Cox 比例风险模型中，与每 1 SD log CAC 相关的风险比为 1.40（95%CI，1.16-1.69；P<0.001）用于心血管疾病，1.44（95%CI，1.02-2.02；P=0.04）用于心肌梗死，1.39（95%CI，1.10-1.76；P=0.006）用于心力衰竭，以及 1.19（95%CI，0.94-1.51；P=0.15）用于全因死亡率。此外，在预测心血管疾病方面，CAC 评分的纳入导致 C 统计量增加了 0.02（95%CI，0-0.09；P<0.001），而使用所有上述已建立和新的心血管疾病风险因素则没有增加。
冠状动脉钙化与 CKD 患者心血管疾病、心肌梗死和心力衰竭的风险独立且显著相关。此外，CAC 可改善 CKD 患者心血管疾病、心肌梗死和心力衰竭风险预测，优于使用已建立和新的心血管疾病风险因素；然而，C 统计量的变化很小。
