Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing 100005, China.
Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing 100020, China.
Int J Environ Res Public Health. 2022 Dec 5;19(23):16300. doi: 10.3390/ijerph192316300.
Many studies suggest that cardiovascular-related mortality is higher in patients with end-stage renal disease, but few focus on the risk of atherosclerotic cardiovascular disease (ASCVD) in subjects with normal to slightly reduced kidney function. Our study aimed to explore the association between normal to slightly decreased estimated glomerular filtration rate (eGFR) and 10-year ASCVD risk levels among subjects with relative health conditions. A total of 12,986 subjects from the Chinese Physiological Constant and Health Condition survey were included. We used the Chronic Kidney Disease Epidemiology Collaboration equations to calculate eGFR and the 10-year ASCVD risk scores to assess the subjects' risk of 10-year ASCVD. Ordinal logistic regression analysis was conducted to explore the association between ASCVD risk levels and eGFR, and adjust the possible confounding factors. Results indicated that the 10-year ASCVD risk scores gradually increased following the decrease in eGFR. Subjects who had smaller eGFR were more likely to have a greater risk of 10-year ASCVD. Additionally, the association between eGFR and 10-year ASCVD risk level changed with varying eGFR. The risk of one or more levels increasing in the 10-year ASCVD risk group was 5.20 times (Quartile 2 [Q2], 95%CI: 3.90, 6.94), 9.47 times (Q3, 95%CI: 7.15, 12.53) and 11.41 times (Q4, 95%CI: 8.61, 15.12) higher compared with Q1. We found that eGFR was significantly associated with 10-year ASCVD risk among Chinese subjects with normal to slightly reduced kidney function. Therefore, clinicians should strengthen the monitoring of cardiovascular risk in patients with renal impairment (even if renal function is only mildly reduced), assess the patients' risk of ASCVD, and take early action in high-risk groups to reduce the risk of adverse atherosclerotic cardiovascular events.
许多研究表明，终末期肾病患者的心血管相关死亡率较高，但很少关注肾功能正常或轻度降低的患者发生动脉粥样硬化性心血管疾病（ASCVD）的风险。我们的研究旨在探讨肾功能正常或轻度降低的受试者中，估计肾小球滤过率（eGFR）正常至轻度降低与 10 年 ASCVD 风险水平之间的关系。本研究共纳入了来自中国生理常数和健康状况调查的 12986 名受试者。我们使用慢性肾脏病流行病学合作方程计算 eGFR，并使用 10 年 ASCVD 风险评分评估受试者 10 年 ASCVD 的风险。采用有序逻辑回归分析探讨 ASCVD 风险水平与 eGFR 的关系，并调整可能的混杂因素。结果表明，随着 eGFR 的降低，10 年 ASCVD 风险评分逐渐升高。eGFR 较低的受试者发生 10 年 ASCVD 的风险更高。此外，eGFR 与 10 年 ASCVD 风险水平之间的关系随 eGFR 的变化而变化。10 年 ASCVD 风险组中一个或多个水平增加的风险分别为 Q2（四分位间距 2）的 5.20 倍（95%CI：3.90，6.94），Q3（95%CI：7.15，12.53）的 9.47 倍和 Q4（95%CI：8.61，15.12）的 11.41 倍。我们发现，在中国肾功能正常或轻度降低的受试者中，eGFR 与 10 年 ASCVD 风险显著相关。因此，临床医生应加强对肾功能损害患者（即使肾功能仅轻度降低）心血管风险的监测，评估患者 ASCVD 的风险，并在高危人群中采取早期行动，降低不良动脉粥样硬化性心血管事件的风险。
