Suh-Chiou Cheng, Moysés Rosa M, Bittencourt Marcio S, Bensenor Isabela M, Lotufo Paulo A
Internal Medicine Division, Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, São Paulo, Brazil.
Clin Cardiol. 2017 Dec;40(12):1309-1315. doi: 10.1002/clc.22829. Epub 2017 Dec 15.
Chronic kidney disease is a worldwide public health concern due to the increased prevalence the high fatalities related to heart disease in this population. Among novel cardiovascular risk markers, the coronary artery calcification score (CAC) emerged as an independent predictor of cardiovascular events.
We aimed to test if glomerular filtration rate or albuminuria are independently associated with coronary calcification.
The Brazilian Longitudinal Study of Adult Health is a cohort of men and women aged 35 to 74 years old addressing cardiovascular diseases. We analyzed the association of CAC, estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR) according to stages of eGFR (1 = ≥90; 2 = 60-89; 3 = <60 mL/min/1.73 m ), and ACR (<30; 30 to 300; >300 mg/g). These associations were estimated by logistic regression with a model including age, sex, race, income, and cardiovascular risk factors.
Among 4189 persons (median age = 51 years, 54% women), 1183 had CAC. The odds ratio (OR) and the 95% confidence interval (95% CI) in the multivariate model was 0.86 (0.58-1.29) for the category of eGFR <60 mL/min/1.73 m compared to people with eGFR >90 mL/min/1.73m . On the other hand, the OR (95% CI) for individuals with ACR >300 mg/g was 4.31 (1.27-14.64) compared to people with ACR <30 mg/g. A discrete interaction factor for the association with CAC between eGFR and ACR were analyzed as continuous variable.
Albuminuria was independently associated with coronary calcification, but the reduction of the glomerular filtration rate was not associated with CAC score in this sample of apparently healthy adults.
慢性肾脏病是一个全球性的公共卫生问题，因为该人群中心脏病相关的患病率和高死亡率不断上升。在新型心血管风险标志物中，冠状动脉钙化评分（CAC）已成为心血管事件的独立预测指标。
我们旨在检验肾小球滤过率或蛋白尿是否与冠状动脉钙化独立相关。
巴西成人健康纵向研究是一项针对35至74岁人群的心血管疾病队列研究。我们根据估算肾小球滤过率（eGFR）的阶段（1 = ≥90；2 = 60 - 89；3 = <60 mL/min/1.73 m²）以及白蛋白与肌酐比值（ACR）（<30；30至300；>300 mg/g）分析了CAC、估算肾小球滤过率（eGFR）和白蛋白与肌酐比值（ACR）之间的关联。这些关联通过逻辑回归进行估算，模型包括年龄、性别、种族、收入和心血管危险因素。
在4189名参与者（中位年龄 = 51岁，54%为女性）中，1183人有冠状动脉钙化。与eGFR >90 mL/min/1.73m²的人群相比，eGFR <60 mL/min/1.73 m²组在多变量模型中的比值比（OR）和95%置信区间（95%CI）为0.86（0.58 - 1.29）。另一方面，与ACR <30 mg/g的人群相比，ACR >300 mg/g个体的OR（95%CI）为4.31（1.27 - 14.64）。将eGFR和ACR之间与冠状动脉钙化关联的离散交互因子作为连续变量进行分析。
在这个看似健康的成年人样本中，蛋白尿与冠状动脉钙化独立相关，但肾小球滤过率降低与冠状动脉钙化评分无关。
