亚临床动脉粥样硬化负担可预测糖尿病合并慢性肾脏病患者的心血管事件。
Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease.
机构信息
Department of Endocrinology & Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916, Badalona, Spain.
Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain.
出版信息
Cardiovasc Diabetol. 2019 Jul 19;18(1):93. doi: 10.1186/s12933-019-0897-y.
BACKGROUND
Individuals with diabetes have remarkably high rates of cardiovascular morbidity and mortality. However, the incremental cardiovascular risk in diabetes is heterogeneous and has often been related to renal involvement. The purpose of this study was to analyse the prognostic value of subclinical atherosclerosis in determining the incidence of first cardiovascular events (CVEs) in individuals with diabetes and chronic kidney disease (CKD) compared to CKD individuals without diabetes.
METHODS
We included data from individuals with CKD with and without diabetes, free from pre-existing cardiovascular disease, from the NEFRONA cohort. Participants underwent baseline carotid and femoral ultrasound and were followed up for 4 years. All CVEs during follow-up were registered. Bivariate analysis and Fine-Gray competing risk models were used to perform the statistical analysis.
RESULTS
During the mean follow-up time of 48 months, a total of 203 CVE was registered. 107 CVE occurred among participants without diabetes (19.58 per 1000 person-years) and 96 CVE occurred among participants with diabetes (44.44 per 1000 person-years). Following the competing risk analysis, the variables predicting CVEs in CKD individuals without diabetes were the number of territories with plaque at baseline (HR 1.862, 95% CI [1.432;2.240]), age (HR 1.026, 95% CI [1.003;1.049]) and serum concentrations of 25-OH vitamin D (HR 0.963, 95% CI [0.933;0.094]). The only variable predicting CVEs among CKD participants with diabetes was the number of territories with plaque at baseline (HR 1.782, 95% CI [1.393, 2.278]). For both models, concordance (C) index yielded was over 0.7.
CONCLUSIONS
The burden of subclinical atherosclerosis is the strongest predictor of future CVEs in diabetic individuals with CKD. Early detection of subclinical atherosclerotic burden by multiterritorial vascular ultrasound could improve CVE prediction in this population.
背景
患有糖尿病的个体具有极高的心血管发病率和死亡率。然而，糖尿病患者的心血管风险增加是不均匀的，并且常常与肾脏受累有关。本研究的目的是分析亚临床动脉粥样硬化在确定患有糖尿病和慢性肾脏病（CKD）的个体与无糖尿病的 CKD 个体相比首次发生心血管事件（CVE）的发生率方面的预后价值。
方法
我们纳入了来自 NEFRONA 队列的、无预先存在的心血管疾病的 CKD 合并或不合并糖尿病的个体的数据。参与者接受了基线颈动脉和股动脉超声检查，并随访了 4 年。在随访期间登记了所有 CVE。使用双变量分析和 Fine-Gray 竞争风险模型进行统计分析。
结果
在平均 48 个月的随访期间，共登记了 203 例 CVE。107 例 CVE 发生在无糖尿病的参与者中（19.58 例/1000 人年），96 例 CVE 发生在糖尿病患者中（44.44 例/1000 人年）。经过竞争风险分析，无糖尿病 CKD 个体中预测 CVE 的变量为基线时斑块存在的部位数量（HR 1.862，95%CI [1.432;2.240]）、年龄（HR 1.026，95%CI [1.003;1.049]）和血清 25-羟维生素 D 浓度（HR 0.963，95%CI [0.933;0.094]）。预测糖尿病 CKD 参与者中 CVE 的唯一变量是基线时斑块存在的部位数量（HR 1.782，95%CI [1.393，2.278]）。对于这两个模型，一致性（C）指数均超过 0.7。
结论
亚临床动脉粥样硬化的负担是预测 CKD 合并糖尿病个体未来 CVE 的最强预测因子。通过多部位血管超声早期检测亚临床动脉粥样硬化负担可以改善该人群的 CVE 预测。
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