1 Department of Cardiology, County Emergency Hospital Timisoara, "Victor Babes" University of Medicine and Pharmacy , Timisoara, Romania .
2 Department of Diabetology, Nutrition and Metabolic Diseases, County Emergency Hospital Timisoara, "Victor Babes" University of Medicine and Pharmacy , Timisoara, Romania .
J Womens Health (Larchmt). 2017 Nov;26(11):1201-1213. doi: 10.1089/jwh.2016.6081. Epub 2017 May 24.
Due to loss of hormonal protective effects, postmenopausal women have an increased cardiovascular (CV) risk. Chronic kidney disease (CKD) is a well-established risk factor for CV disease, but little is known whether mild-to-moderate kidney dysfunction is associated with atherosclerosis burden in the postmenopausal asymptomatic women.
Subclinical atherosclerosis was evaluated in 125 postmenopausal women with no clinical form of atherosclerosis, by carotid and femoral ultrasonography, ankle-brachial index (ABI), and flow-mediated dilation (FMD). Carotid and femoral atherosclerosis were defined as increased intima-media thickness (IMT) and/or the presence of plaques. Endothelial function was assessed by endothelial dependent (flow-mediated dilation at 1 minute [FMD]) and independent (flow-mediated dilation after nitroglycerin [FMD]) vasodilation. Classical CV risk factors (age, smoking, obesity, diabetes, blood pressure, and lipids) were evaluated. Kidney function was evaluated in terms of estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI formula. Univariate linear regression and multivariate logistic regressions were used to evaluate the independent associations between kidney function and markers of subclinical atherosclerosis.
In the unadjusted linear analysis, eGFR showed a significant negative association with markers of subclinical atherosclerosis: carotid IMT (R = 0.305; p < 0.001), femoral IMT (R = 0.19, p < 0.001), carotid plaques (R = 0.22; p < 0.001), femoral plaques (R = 0.09; p = 0.0005), ABI (R = 0.05; p = 0.01), FMD (R = 0.45; p < 0.001), and FMD (R = 0.205, p < 0.001). After adjustment for classical CV risk factors the association remained significant.
Mild-to-moderate reduced eGFR is related to subclinical atherosclerosis, independent of traditional CV risk factors. It is important to detect renal function decline, even if it is mild, to improve risk stratification of subclinical atherosclerosis in postmenopausal women.
由于失去了激素的保护作用，绝经后女性的心血管（CV）风险增加。慢性肾脏病（CKD）是心血管疾病的一个既定危险因素，但对于轻度至中度肾功能障碍是否与绝经后无症状女性的动脉粥样硬化负担有关，知之甚少。
通过颈动脉和股动脉超声、踝臂指数（ABI）和血流介导的扩张（FMD），评估了 125 名无临床动脉粥样硬化表现的绝经后女性的亚临床动脉粥样硬化情况。将颈动脉和股动脉粥样硬化定义为内膜中层厚度增加（IMT）和/或斑块形成。内皮功能通过内皮依赖性（1 分钟时的血流介导扩张[FMD]）和独立（硝酸甘油后血流介导扩张[FMD]）血管扩张来评估。评估了经典心血管危险因素（年龄、吸烟、肥胖、糖尿病、血压和血脂）。通过 CKD-EPI 公式计算肾小球滤过率（eGFR）来评估肾功能。采用单变量线性回归和多变量逻辑回归分析评估肾功能与亚临床动脉粥样硬化标志物之间的独立相关性。
在未经调整的线性分析中，eGFR 与亚临床动脉粥样硬化标志物呈显著负相关：颈动脉 IMT（R=0.305；p<0.001）、股动脉 IMT（R=0.19，p<0.001）、颈动脉斑块（R=0.22；p<0.001）、股动脉斑块（R=0.09；p=0.0005）、ABI（R=0.05；p=0.01）、FMD（R=0.45；p<0.001）和 FMD（R=0.205，p<0.001）。在调整经典心血管危险因素后，这种相关性仍然显著。
轻度至中度 eGFR 降低与亚临床动脉粥样硬化有关，与传统心血管危险因素无关。即使肾功能轻度下降，也很重要，以改善绝经后女性亚临床动脉粥样硬化的风险分层。
