Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
Am J Cardiol. 2020 Feb 15;125(4):630-635. doi: 10.1016/j.amjcard.2019.11.019. Epub 2019 Nov 21.
Patients with chronic kidney disease (CKD) are at increased risk for peripheral arterial disease (PAD). A novel biomarker to accurately and reliably predict new onset PAD in high risk patients is needed. High sensitivity troponin (HsTP) is a new assay which allows detection of very low troponin levels with high precision. We sought to explore the association between HsTP and risk of PAD in CKD. The Chronic Renal Insufficiency Cohort (CRIC) is a prospective cohort of 3,939 individuals with mild to moderate CKD using age related criteria for glomerular filtration rate. High sensitivity troponin T was measured at study enrollment. Patients with previous history of PAD or coronary artery disease were excluded. Patients were followed for new-onset adjudicated PAD, and the association between HsTP and incident PAD was examined. A total of 2,909 participants free of PAD and coronary artery disease at enrollment were included in this analysis. Over a mean follow up 7.4 years [interquartile ranges 5.8 to 8.5] years, 79 (2.7%) patients developed PAD. The 3-, 6-, and 9-year incidence of PAD was 1.00%, 2.03%, and 2.72%, respectively. At 9 years, the cumulative rates of PAD increased with HsTP (Quartile 1: 0.3%, Quartile 2: 2.4%, Quartile 3: 3.7%, Quartile 4: 10.7%; p <0.001). After adjusting for clinical risk factors of PAD, patients in the third quartile (Hazards ratio 5.89, 95% confidence interval: 1.31 to 26.47, p = 0.021) and fourth quartile of HsTP (Hazards ratio 10.24, 95% confidence interval 2.23 to 47.08, p = 0.003) had higher risk of PAD compared with lowest quartile of HsTP. HsTP had good discrimination of PAD at 3 years (area under the curve [AUC] 0.76), 6 years (AUC 0.79) and 9 years (AUC 0.80). Addition of HsTP to Framingham risk score improved model discrimination of PAD. In conclusion, in patients with mild-moderate CKD, HsTP levels are associated with and predictive of risk of incident PAD. This association remains significant despite adjustment for traditional PAD risk factors and chronic kidney disease.
患有慢性肾脏病（CKD）的患者发生外周动脉疾病（PAD）的风险增加。需要一种新的生物标志物来准确可靠地预测高危患者新发生的 PAD。高敏肌钙蛋白（HsTP）是一种新的检测方法，可高精度检测非常低水平的肌钙蛋白。我们试图探讨 HsTP 与 CKD 患者 PAD 风险之间的关系。慢性肾脏不全队列（CRIC）是一项前瞻性队列研究，纳入了 3939 名年龄相关肾小球滤过率轻度至中度 CKD 患者。在研究入组时测量了高敏肌钙蛋白 T。排除了有 PAD 或冠心病既往史的患者。随访新发生的经裁决的 PAD，并检查 HsTP 与 PAD 发病的关系。在这项分析中，共有 2909 名在入组时无 PAD 和冠心病的参与者被纳入。中位随访时间为 7.4 年[四分位距 5.8 至 8.5 年]，79 名（2.7%）患者发生 PAD。3 年、6 年和 9 年的 PAD 发生率分别为 1.00%、2.03%和 2.72%。9 年后，HsTP 与 PAD 的累积发生率呈正相关（四分位数 1：0.3%，四分位数 2：2.4%，四分位数 3：3.7%，四分位数 4：10.7%；p<0.001）。在调整了 PAD 的临床危险因素后，第 3 四分位数（危险比 5.89，95%置信区间：1.31 至 26.47，p=0.021）和第 4 四分位数的 HsTP（危险比 10.24，95%置信区间 2.23 至 47.08，p=0.003）患者发生 PAD 的风险高于 HsTP 最低四分位数。HsTP 在 3 年（曲线下面积[AUC]0.76）、6 年（AUC 0.79）和 9 年（AUC 0.80）时对 PAD 有良好的鉴别能力。在Framingham 风险评分中加入 HsTP 可提高 PAD 模型的判别能力。总之，在轻度至中度 CKD 患者中，HsTP 水平与 PAD 发病风险相关，并可预测 PAD 发病风险。尽管调整了传统的 PAD 危险因素和慢性肾脏病，但这种相关性仍然显著。
