The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Rehabilitation Science, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.
Am J Nephrol. 2022;53(2-3):240-248. doi: 10.1159/000522147. Epub 2022 Mar 8.
Evidence is lacking regarding the association between cardiovascular health (CVH) metrics and the risk for proteinuria.
We performed this observational cohort study including 865,087 participants (median age, 46 years, 60.7% men) with negative proteinuria at the initial health check-up, who underwent repeated health check-ups within 4 years. Ideal CVH metrics included nonsmoking, body mass index <25 kg/m2, physical activity at goal, eating breakfast, blood pressure <120/80 mm Hg, fasting plasma glucose <100 mg/dL, and total cholesterol <200 mg/dL. The primary outcome was incident proteinuria, defined as ≥1 + on the urine dipstick test.
Participants were categorized as having low CVH metrics defined as having 0-2 ideal CVH metrics (n = 84,439), middle CVH metrics defined as having 3-4 ideal CVH metrics (n = 335,773), and high CVH metrics defined as having 5-7 ideal CVH metrics (n = 444,875). Compared with low CVH metrics, middle CVH metrics (odds ratio (OR): 0.61, 95% CI: 0.59-0.63) and high CVH metrics (OR: 0.45, 95% CI: 0.43-0.46) were associated with a lower risk of proteinuria. The OR of a one-point increase in the ideal number of CVH metrics was 0.83 (95% CI: 0.82-0.83). All CVH metrics components except for ideal total cholesterol were associated with a decreased risk of proteinuria. A one-point improvement in the number of ideal CVH metrics at 1 year after the initial health check-up was associated with a decreased incidence of proteinuria (OR: 0.90, 95% CI: 0.89-0.92).
Not only maintaining better CVH metrics but also improving CVH metrics would prevent developing proteinuria in a general population.
目前缺乏心血管健康（CVH）指标与蛋白尿风险之间关联的证据。
我们进行了这项观察性队列研究，纳入了 865087 名在初始健康检查时尿蛋白阴性、在 4 年内接受重复健康检查的参与者（中位年龄 46 岁，60.7%为男性）。理想的 CVH 指标包括不吸烟、体重指数<25kg/m2、达到目标的身体活动量、吃早餐、血压<120/80mmHg、空腹血糖<100mg/dL 和总胆固醇<200mg/dL。主要结局是新发蛋白尿，定义为尿试纸检测≥1+。
参与者被分为 CVH 指标低（定义为有 0-2 项理想 CVH 指标，n=84439）、中（定义为有 3-4 项理想 CVH 指标，n=335773）和高（定义为有 5-7 项理想 CVH 指标，n=444875）。与 CVH 指标低相比，中（比值比[OR]：0.61，95%置信区间[CI]：0.59-0.63）和高（OR：0.45，95%CI：0.43-0.46）CVH 指标与蛋白尿风险降低相关。理想 CVH 指标每增加一项的 OR 为 0.83（95%CI：0.82-0.83）。除理想总胆固醇外，所有 CVH 指标成分均与蛋白尿风险降低相关。在初始健康检查后 1 年，理想 CVH 指标数量增加 1 分与蛋白尿发生率降低相关（OR：0.90，95%CI：0.89-0.92）。
不仅要保持更好的 CVH 指标，还要改善 CVH 指标，才能预防一般人群发生蛋白尿。
