Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
J Am Heart Assoc. 2018 Jan 12;7(2):e007209. doi: 10.1161/JAHA.117.007209.
Reduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin-to-creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels.
Using 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996-1998, we explored the cross-sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13 g/dL in men and <12 g/dL in women) and 7.2% had high hemoglobin (≥16 g/dL in men and ≥15 g/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59-2.82) for eGFR 30 to 59 compared with ≥90 mL/min per 1.73 m and 1.45 (1.07-1.95) for ACR ≥30 compared with <10 mg/g. ACR ≥30 mg/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12-2.19] compared with <10 mg/g). During follow-up, there were 1069 incident CVDs among 5098 CVD-free participants at baseline. In multivariable Cox models, lower eGFR, higher ACR, and anemia were each independently associated with CVD risk, with the association of low eGFR being slightly stronger in anemia (-for-interaction, 0.072). There was no hemoglobin-ACR interaction; however, when CVD subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high ACR was slightly stronger in high hemoglobin (-for-interaction, 0.074).
Kidney function, albuminuria, and anemia were correlated and independently associated with CVD risk. Correlation and potential interaction for atherosclerotic CVD between albuminuria and high hemoglobin deserve further investigation.
估算肾小球滤过率（eGFR）降低和尿白蛋白与肌酐比值（ACR）升高均会增加心血管疾病（CVD）的风险。我们假设，在血红蛋白水平异常（无论是偏低还是偏高）的人群中，这些关联更为显著。
本研究利用 1996-1998 年 ARIC（社区动脉粥样硬化风险研究）研究中 5801 名可获得血红蛋白检测值的参与者，通过 2013 年的随访，探讨了 eGFR 和 ACR 与血红蛋白水平的横断面关联及其与 CVD（心力衰竭、冠心病和中风）风险的纵向关联。基线时，8.8%的人患有贫血症（男性＜13 g/dL，女性＜12 g/dL），7.2%的人血红蛋白偏高（男性≥16 g/dL，女性≥15 g/dL）。与 eGFR 30-59 mL/min/1.73 m 相比，eGFR ＜30 mL/min/1.73 m 的贫血症患病率比为 2.12（95%置信区间，1.59-2.82），与 ACR ＜10 mg/g 相比，ACR ≥30 mg/g 的患病率比为 1.45（1.07-1.95）。ACR ≥30 mg/g 也与血红蛋白偏高相关（与＜10 mg/g 相比，患病率比为 1.57 [1.12-2.19]）。在随访期间，5098 名基线时无 CVD 的参与者中有 1069 人发生了 CVD。在多变量 Cox 模型中，较低的 eGFR、较高的 ACR 和贫血症均与 CVD 风险独立相关，而贫血症患者中 eGFR 较低的相关性稍强（交互检验，0.072）。血红蛋白与 ACR 之间没有交互作用；然而，当单独分析 CVD 亚型时，高 ACR 与冠心病和中风风险的相关性在血红蛋白偏高时略强（交互检验，0.074）。
肾脏功能、蛋白尿和贫血症相互关联且与 CVD 风险独立相关。白蛋白尿与高血红蛋白之间与动脉粥样硬化性 CVD 的相关性及其潜在交互作用值得进一步研究。
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