Department of Pharmacology and Molecular Therapeutics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Sci Rep. 2018 Feb 16;8(1):3150. doi: 10.1038/s41598-018-20874-4.
The ATTEMPT-CVD study was prospective randomized active-controlled trial and the main findings had been reported. According to baseline GFR and albuminuria categories, we divided the patients of the ATTEMPT-CVD study into 2 subgroups: (Group 1) the patients with at least one of eGFR of <45 ml/min per 1.73 m and UACR of ≥300 mg/g creatinine, defined as G3b and/or A3; (Group 2) the patients except for Group 1, defined as the other patients. In patients with G3b and/or A3, the incidence of cardiovascular events was significantly less in ARB group than in non-ARB group (11 vs 22, respectively) (HR = 0.465: 95%CI = 0.224-0.965; P = 0.040). UACR was significantly less in ARB group than in non-ARB group during follow-up period in patients with G3b and/or A3 (P = 0.0003), while eGFR, plasma BNP levels, and blood pressure were comparable between ARB and non-ARB groups. Allocation to ARB therapy was a significant independent prognostic factor for cardiovascular events in patients with G3b and/or A3 (P = 0.0268). On the other hand, in the other patients, the occurrence of cardiovascular events was comparable between ARB and non-ARB groups. In patients with advanced CKD, ARB-based therapy may confer greater benefit in prevention of cardiovascular events than non-ARB therapy.
ATTEMPT-CVD 研究为前瞻性随机活性对照试验，主要研究结果已报道。根据基线肾小球滤过率（GFR）和白蛋白尿类别，我们将 ATTEMPT-CVD 研究的患者分为 2 个亚组：（组 1）至少有一个 eGFR<45 ml/min/1.73 m 和 UACR≥300 mg/g 肌酐的患者，定义为 G3b 和/或 A3；（组 2）除组 1 以外的患者，定义为其他患者。在 G3b 和/或 A3 患者中，ARB 组的心血管事件发生率明显低于非 ARB 组（分别为 11 例和 22 例）（HR=0.465：95%CI=0.224-0.965；P=0.040）。在 G3b 和/或 A3 患者中，ARB 组在随访期间的 UACR 明显低于非 ARB 组（P=0.0003），而 eGFR、血浆 BNP 水平和血压在 ARB 和非 ARB 组之间无差异。ARB 治疗的分配是 G3b 和/或 A3 患者心血管事件的独立预后因素（P=0.0268）。另一方面，在其他患者中，ARB 和非 ARB 组的心血管事件发生率无差异。在晚期 CKD 患者中，ARB 治疗在预防心血管事件方面的获益可能优于非 ARB 治疗。
