慢性肾脏病中心血管健康指标与全因死亡率和心血管疾病死亡率的关联：一项队列研究。

Association of cardiovascular health metrics with all-cause and cardiovascular disease mortality in chronic kidney disease: A cohort study.

作者信息

Zhang Shanshan, Xue Qingping, Li Di, Xu Ying, Zhang Yan-Bo, Peng Jieru, Wu Shiyi, He Xingchen, Yang Xue, Liu Yanjun, Yan Tong, Wu Nianwei, Wen Ying, Cravens Lauryn, Wu Jason Hy, Yang Chun-Xia, Pan Xiong-Fei

机构信息

Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Department of Epidemiology and Biostatistics, School of Public Health, Chengdu Medical College, Chengdu, Sichuan 610500, China.

出版信息

Nutr Metab Cardiovasc Dis. 2024 Aug;34(8):1837-1845. doi: 10.1016/j.numecd.2024.03.024. Epub 2024 Mar 23.

DOI:10.1016/j.numecd.2024.03.024

PMID:38760189

Abstract

BACKGROUND AND AIMS

Since the global burden of chronic kidney disease (CKD) is rising rapidly, the study aimed to assess the association of cardiovascular health (CVH) metrics with all-cause and cardiovascular disease (CVD) mortality among individuals with CKD.

METHODS AND RESULTS

The cohort study included 5834 participants with CKD from the National Health and Nutrition Examination Survey 1999-2018. A composite CVH score was calculated based on smoking status, physical activity, body mass index, blood pressure, total cholesterol, diet quality, and glucose control. Primary outcomes were all-cause and CVD mortality as of December 31, 2019. Multivariable-adjusted Cox proportional hazards models were used to estimate the association between CVH metrics and deaths in CKD patients. During a median follow-up of 7.2 years, 2178 all-cause deaths and 779 CVD deaths were documented. Compared to participants with ideal CVH, individuals with intermediate CVH exhibited a 46.0% increase in all-cause mortality (hazard ratio, 1.46; 95% confidence interval: 1.17, 1.83), while those with poor CVH demonstrated a 101.0% increase (2.01; 1.54, 2.62). For CVD mortality, individuals with intermediate CVH experienced a 56.0% increase (1.56; 1.02, 2.39), and those with poor CVH demonstrated a 143.0% increase (2.43; 1.51, 3.91). Linear trends were noted for the associations of CVH with both all-cause mortality (P for trend <0.001) and CVD mortality (P for trend = 0.02).

CONCLUSIONS

Lower CVH levels were associated with higher all-cause and CVD mortality in individuals with CKD, which highlights the importance of maintaining good CVH in CKD patients.

摘要

背景与目的

鉴于全球慢性肾脏病（CKD）负担迅速上升，本研究旨在评估心血管健康（CVH）指标与CKD患者全因死亡率和心血管疾病（CVD）死亡率之间的关联。

方法与结果

该队列研究纳入了1999 - 2018年美国国家健康与营养检查调查中的5834例CKD患者。基于吸烟状况、身体活动、体重指数、血压、总胆固醇、饮食质量和血糖控制情况计算综合CVH评分。主要结局为截至2019年12月31日的全因死亡率和CVD死亡率。采用多变量调整的Cox比例风险模型来估计CKD患者中CVH指标与死亡之间的关联。在中位随访7.2年期间，记录到2178例全因死亡和779例CVD死亡。与具有理想CVH的参与者相比，具有中等CVH的个体全因死亡率增加了46.0%（风险比，1.46；95%置信区间：1.17，1.83），而具有较差CVH的个体则增加了101.0%（2.01；1.54，2.62）。对于CVD死亡率，具有中等CVH的个体增加了56.0%（1.56；1.02，2.39），而具有较差CVH的个体增加了143.0%（2.43；1.51，3.91）。CVH与全因死亡率（趋势P<0.001）和CVD死亡率（趋势P = 0.02）之间的关联均呈现线性趋势。