Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2019 Feb 1;22(2):91-98.
We investigated the association of estimated glomerular filtration rate (eGFR) with Framingham risk score (FRS), and actual cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM). We also assessed improvement in FRS for prediction of CVD after inclusion of eGFR and albuminuria.
A total of 571 patients with T2DM and mean age 55 were divided into 2 groups based on the presence of CVD. Participants without CVD were then divided into three groups according to FRS. CVD is defined as an episode of CCU admission, Myocardial infarction, history of coronary artery bypass graft surgery or percutaneous intervention. FRS is calculated using the Wilson 1998 Circulation equation, which includes age, sex, high blood pressure, smoking, high-density lipoprotein (HDL), total cholesterol and diabetes as components to assess CVD risk in 10 years.
An inverse adjusted association between eGFR and prevalent CVD was confirmed by multiple logistic regression analysis (OR = 0.84, 95% CI: 0.74, 0.94, P = 0.03). We observed every 10 mL/min/1.73 m2 decrease in eGFR is related to 3% increase in FRS in patients without chronic kidney disease (CKD) (coefficient = -0.03, P < 0.001). The association between FRS and GFR and also CVD and eGFR were not significant in patients with CKD (P = 0.12; P = 0.17, respectively). Predictive values for FRS components with and without considering eGFR and albuminuria were calculated (0.74 and 0.75, respectively).
Inclusion of eGFR and albuminuria in the FRS formula did not improve the predictive value of the model. We showed an inverse association between eGFR and FRS in early stages of diabetic kidney disease, which was lost in patients with CKD.
我们研究了估算肾小球滤过率（eGFR）与 Framingham 风险评分（FRS）以及 2 型糖尿病（T2DM）患者实际心血管疾病（CVD）之间的关系。我们还评估了纳入 eGFR 和白蛋白尿后，FRS 对 CVD 预测的改善情况。
共有 571 名 T2DM 患者，平均年龄为 55 岁，根据 CVD 的存在将其分为两组。无 CVD 的患者再根据 FRS 分为三组。CVD 定义为 CCU 入院、心肌梗死、冠状动脉旁路移植术或经皮介入治疗的病史。FRS 是使用 Wilson 1998 年的循环方程计算的，该方程包括年龄、性别、高血压、吸烟、高密度脂蛋白（HDL）、总胆固醇和糖尿病作为评估 10 年内 CVD 风险的成分。
多因素逻辑回归分析证实 eGFR 与现患 CVD 之间存在反向调整关联（OR = 0.84，95%CI：0.74，0.94，P = 0.03）。我们发现，在无慢性肾脏病（CKD）的患者中，eGFR 每降低 10 mL/min/1.73 m2，FRS 就会升高 3%（系数=-0.03，P<0.001）。在 CKD 患者中，FRS 与 GFR 以及 CVD 与 eGFR 之间的关联不显著（P = 0.12；P = 0.17）。计算了不考虑 eGFR 和白蛋白尿的 FRS 成分的预测值（分别为 0.74 和 0.75）。
在 FRS 公式中纳入 eGFR 和白蛋白尿并没有提高模型的预测值。我们在糖尿病肾病早期阶段显示出 eGFR 与 FRS 之间存在负相关关系，但在 CKD 患者中这种关系消失了。
