Tyson Crystal C, Smith Patrick J, Sherwood Andrew, Mabe Stephanie, Hinderliter Alan L, Blumenthal James A
Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Clin Kidney J. 2017 Oct;10(5):666-671. doi: 10.1093/ckj/sfx025. Epub 2017 May 2.
Moderate-to-severe kidney dysfunction is associated with atherosclerotic cardiovascular disease (ASCVD). Gradations of normal or mildly reduced kidney function may also associate with ASCVD risk.
We conducted a secondary analysis using baseline data from the Exercise and Nutritional Interventions for Cardiovascular Health (ENCORE) trial. Participants were sedentary, overweight and obese adults with unmedicated pre-hypertension or Stage I hypertension and an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m. The Pooled Cohorts Equations were used to estimate a 10-year risk for first ASCVD event. Carotid artery intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were measured to assess subclinical atherosclerosis and vascular endothelial function, respectively. Using linear regression, we examined the association between eGFR and ASCVD risk, IMT and FMD.
Participants ( = 139) were predominantly women (65%), white (60%), with a mean age of 52.0 ± 9.6 years and mean eGFR of 89.1 ± 15.0 mL/min/1.73 m. Lower eGFR of 15 mL/min/1.73 m was associated with higher ASCVD risk [ = -2.7% (95% confidence interval: -3.7, -1.8%), P < 0.001], higher IMT [ = 0.05 mm (0.03, 0.08 mm), P < 0.001] and lower FMD [ = -0.87% (-1.64, -0.11%), P = 0.026]. Compared with eGFR ≥90 mL/min/1.73 m, those with eGFR 60-89 mL/min/1.73 m had higher mean ASCVD risk (7.6% versus 2.7%; P < 0.001), greater mean IMT (0.74 mm versus 0.66 mm; P < 0.001) and lower mean FMD (2.0% versus 3.7%; P = 0.026). After controlling for CVD risk factors, the association between eGFR and IMT remained significant (P < 0.001), and eGFR and FMD trended toward significance (P = 0.08).
Among overweight and obese adults with unmedicated high blood pressure and eGFR ≥60 mL/min/1.73 m, lower eGFR is associated with a greater 10-year risk for first ASCVD event, higher IMT and relatively impaired FMD.
中重度肾功能不全与动脉粥样硬化性心血管疾病（ASCVD）相关。正常或轻度降低的肾功能分级也可能与ASCVD风险相关。
我们使用心血管健康运动与营养干预（ENCORE）试验的基线数据进行了二次分析。参与者为久坐不动、超重和肥胖的成年人，患有未经药物治疗的高血压前期或I期高血压，估计肾小球滤过率（eGFR）≥60 mL/（min·1.73 m²）。使用合并队列方程估计首次发生ASCVD事件的10年风险。测量颈动脉内膜中层厚度（IMT）和肱动脉血流介导的舒张功能（FMD），分别评估亚临床动脉粥样硬化和血管内皮功能。我们使用线性回归分析了eGFR与ASCVD风险、IMT和FMD之间的关联。
参与者（n = 139）主要为女性（65%），白人（60%），平均年龄52.0±9.6岁，平均eGFR为89.1±15.0 mL/（min·1.73 m²）。eGFR每降低15 mL/（min·1.73 m²）与更高的ASCVD风险相关[β = -2.7%（95%置信区间：-3.7，-1.8%），P < 0.001]、更高的IMT[β = 0.05 mm（0.03，0.08 mm），P < 0.001]和更低的FMD[β = -0.87%（-1.64，-0.11%），P = 0.026]。与eGFR≥90 mL/（min·1.73 m²）的参与者相比，eGFR为60 - 89 mL/（min·1.73 m²）的参与者平均ASCVD风险更高（7.6%对2.7%；P < 0.001）、平均IMT更大（0.74 mm对0.66 mm；P < 0.001）且平均FMD更低（2.0%对3.7%；P = 0.026）。在控制心血管疾病风险因素后，eGFR与IMT之间的关联仍然显著（P < 0.001），eGFR与FMD之间的关联有显著趋势（P = 0.08）。
在患有未经药物治疗的高血压且eGFR≥60 mL/（min·1.73 m²）的超重和肥胖成年人中，较低的eGFR与首次发生ASCVD事件的10年风险更高、IMT更高以及FMD相对受损相关。
