Suzuki Keita, Tsujiguchi Hiromasa, Hara Akinori, Nakamura Hiroyuki, Kotani Kazuhiko, Noda Mitsuhiko, Yamakage Hajime, Satoh-Asahara Noriko, Takamura Toshinari
Department of Endocrinology and Metabolism Kanazawa University Graduate School of Medical Sciences Kanazawa Ishikawa Japan.
Department of Hygiene and Public Health Faculty of Medicine Institute of Medical, Pharmaceutical and Health Sciences Kanazawa University Kanazawa Ishikawa Japan.
Obes Sci Pract. 2022 Sep 13;9(1):4-14. doi: 10.1002/osp4.630. eCollection 2023 Feb.
Although many clinical parameters have been identified as predictors for cardiovascular disease (CVD) development in the general population, the accurate predictor for CVD in patients with obesity is still unknown.
The study aimed to explore an additional risk factor and predictor for CVD in patients with overweight/obesity considering the interaction of obesity-related pathophysiology.
The Japan Obesity and Metabolic Syndrome study, a multicenter prospective study, enrolled 787 outpatients, of which 318 eligible patients were analyzed. Patients with fasting plasma glucose (FPG) levels ≥6.11 and < 6.11 mmol/L were considered to have high FPG (HFPG) and normal FPG (NFPG), respectively. Thirty-six patients who developed CVD during the 5 years follow-up were assigned to the CVD group.
Cox's proportional hazards model revealed no significant association between CVD and cystatin C-based estimated glomerular filtration rate (eGFRcys) or creatinine-based eGFR (eGFRcr) in the NFPG group. In the HFPG group, lower eGFRcys, but not eGFRcr, was significantly associated with CVD development. A generalized linear mixed model demonstrated greater reduction in eGFRcys levels over time with HFPG than with NFPG. Although the CVD group showed gradual reduction in eGFRcys levels, the non-CVD group-matched using propensity scores-did not show a decline in eGFRcys levels.
Lower eGFRcys levels may be more accurate than eGFRcr in predicting CVD development in patients with overweight/obesity and hyperglycemia. Furthermore, eGFRcys reduction over time is associated with CVD development.
UMIN000000559.
尽管许多临床参数已被确定为普通人群心血管疾病（CVD）发生的预测指标，但肥胖患者CVD的准确预测指标仍不明确。
考虑肥胖相关病理生理学的相互作用，本研究旨在探索超重/肥胖患者CVD的额外危险因素和预测指标。
日本肥胖与代谢综合征研究是一项多中心前瞻性研究，纳入了787名门诊患者，其中318名符合条件的患者进行了分析。空腹血糖（FPG）水平≥6.11和<6.11 mmol/L的患者分别被认为患有高FPG（HFPG）和正常FPG（NFPG）。在5年随访期间发生CVD的36名患者被分配到CVD组。
Cox比例风险模型显示，在NFPG组中，CVD与基于胱抑素C的估计肾小球滤过率（eGFRcys）或基于肌酐的eGFR（eGFRcr）之间无显著关联。在HFPG组中，较低的eGFRcys而非eGFRcr与CVD发生显著相关。广义线性混合模型显示，与NFPG相比，HFPG患者的eGFRcys水平随时间下降幅度更大。尽管CVD组的eGFRcys水平逐渐降低，但使用倾向评分匹配的非CVD组的eGFRcys水平并未下降。
在预测超重/肥胖和高血糖患者的CVD发生方面，较低的eGFRcys水平可能比eGFRcr更准确。此外，eGFRcys水平随时间的降低与CVD发生有关。
UMIN000000559。
