Cedeño Mora Santiago, Goicoechea Marian, Torres Esther, Verdalles Úrsula, Pérez de José Ana, Verde Eduardo, García de Vinuesa Soledad, Luño José
Departamento de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Departamento de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Nefrologia. 2017 May-Jun;37(3):293-300. doi: 10.1016/j.nefro.2016.10.002. Epub 2017 May 8.
Scores underestimate the prediction of cardiovascular risk (CVR) as they are not validated in patients with chronic kidney disease (CKD). Two of the most commonly used scores are the Framingham Risk Score (FRS-CVD) and the ASCVD (AHA/ACC 2013). The aim of this study is to evaluate the predictive ability of experiencing a cardiovascular event (CVE) via these 2scores in the CKD population.
Prospective, observational study of 400 prevalent patients with CKD (stages 4 and 5 according the KDOQI; not on dialysis). Cardiovascular risk was calculated according to the 2scores and the predictive capacity of cardiovascular events (atherosclerotic events: myocardial infarction, ischaemic and haemorrhagic stroke, peripheral vascular disease; and non-atherosclerotic events: heart failure) was analysed.
Forty-nine atherosclerotic cardiovascular events occurred in 40.3±6.6 months of follow-up. Most of the patients were classified as high CVR by both scores (59% by the FRS-CVD and 75% by the ASCVD). All cardiovascular events occurred in the high CVR patients and both scores (FRS-CVD log-rank 12.2, P<.001, HR 3.1 [95% CI: 1.3-7.1] P: 0.006 and ASCVD log-rank 8.5 P<.001, HR 3.2 [95% CI: 1.1-9.4] P: 0.03) were independent predictors adjusted to renal function, albuminuria and previous cardiovascular events.
The cardiovascular risk scores (FRS-CVD and ASCVD [AHA/ACC 2013]) can estimate the probability of atherosclerotic cardiovascular events in patients with CKD regardless of renal function, albuminuria and previous cardiovascular events.
由于在慢性肾脏病（CKD）患者中未经验证，评分低估了心血管风险（CVR）的预测能力。两种最常用的评分是弗雷明汉姆风险评分（FRS-CVD）和动脉粥样硬化性心血管疾病（ASCVD）评分（美国心脏协会/美国心脏病学会2013年版）。本研究的目的是评估通过这两种评分预测CKD人群发生心血管事件（CVE）的能力。
对400例CKD现患患者（根据美国肾脏病基金会肾脏病预后质量倡议[KDOQI]标准为4期和5期；未接受透析）进行前瞻性观察研究。根据这两种评分计算心血管风险，并分析心血管事件（动脉粥样硬化事件：心肌梗死、缺血性和出血性卒中、外周血管疾病；以及非动脉粥样硬化事件：心力衰竭）的预测能力。
在40.3±6.6个月的随访期间发生了49例动脉粥样硬化性心血管事件。大多数患者根据两种评分均被归类为高CVR（FRS-CVD评分为59%，ASCVD评分为75%）。所有心血管事件均发生在高CVR患者中，两种评分（FRS-CVD对数秩检验为12.2，P<0.001，风险比[HR]为3.1[95%置信区间：1.3-7.1]，P：0.006；ASCVD对数秩检验为8.5，P<0.001，HR为3.2[95%置信区间：1.1-9.4]，P：0.03）经肾功能、蛋白尿和既往心血管事件校正后均为独立预测因素。
心血管风险评分（FRS-CVD和ASCVD[AHA/ACC 2013]）可估计CKD患者发生动脉粥样硬化性心血管事件的概率，而与肾功能、蛋白尿和既往心血管事件无关。
