Xie Haitao, Wang Shi, Qian Li, Yu Peng, Chen Xiaohu, Tang Shuhua, Shen Le
First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China.
Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Sci Rep. 2025 Apr 29;15(1):15001. doi: 10.1038/s41598-025-98506-x.
Our study aims to evaluate the prevalence of elevated cardiac biomarkers, as well as their associations with chronic kidney disease (CKD) and long-term risk of mortality (all-cause and cardiovascular) in the US individuals without known cardiovascular disease. The study population was derived from individuals aged ≥ 20 years in NHANES 1999 to 2004. We calculated the prevalence of elevated cardiac biomarkers in both CKD and non-CKD populations and used multivariable logistic regression to assess the relationships between each cardiac biomarker and CKD. We also used multivariable Cox proportional hazards models and competing risk models to evaluate the adjusted associations between elevated cardiac biomarkers and all-cause and cardiovascular mortality. The crude prevalence of CKD in the overall population was 14.71%. Among CKD individuals, the age-standardized prevalence of elevated NT-ProBNP (≥ 125 pg/mL), hs-cTnT (≥ 6 ng/L), and hs-cTnI (M ≥ 6 ng/L and F ≥ 4 ng/L) were 26.43%, 47.44%, and 19.23%, respectively. After adjusting for cardiovascular and renal risk factors, significant correlations were observed between elevated cardiac biomarkers with CKD. Analysis of follow-up data revealed elevated cardiac biomarkers were independently associated with cumulative occurrence of all-cause mortality (CKD: adjusted hazard ratio [HR]: NT-proBNP: 2.00 [95% CI, 1.56-2.56]; hs-cTnT: 2.89 [95% CI, 1.96-4.26]; hs-cTnI: 1.92 [95% CI, 1.50-2.44]) and cardiovascular mortality (CKD: adjusted hazard ratio [HR]: NT-proBNP: 2.38 [95% CI, 1.61-3.51]; hs-cTnT: 2.70 [95% CI, 1.35-5.40]; hs-cTnI: 2.11 [95% CI, 1.46-3.04]). Additionally, different detection methodologies (Abbott, Siemens, Ortho) do not significantly affect the correlation between hs-cTnI and CKD, with a consistent positive correlation observed. Our research evaluated the substantial burden of elevated cardiac biomarkers in CKD individuals and provided crucial prognostic information regarding the long-term risk of mortality. These findings will offer significant guidance for risk stratification and the formulation of tailored prevention strategies across diverse populations.
我们的研究旨在评估在美国无已知心血管疾病的个体中，心脏生物标志物升高的患病率，以及它们与慢性肾脏病（CKD）和长期死亡风险（全因死亡和心血管死亡）之间的关联。研究人群来自1999年至2004年美国国家健康与营养检查调查（NHANES）中年龄≥20岁的个体。我们计算了CKD和非CKD人群中心脏生物标志物升高的患病率，并使用多变量逻辑回归来评估每种心脏生物标志物与CKD之间的关系。我们还使用多变量Cox比例风险模型和竞争风险模型来评估心脏生物标志物升高与全因死亡和心血管死亡之间的校正关联。总体人群中CKD的粗患病率为14.71%。在CKD个体中，NT-ProBNP（≥125 pg/mL）、高敏心肌肌钙蛋白T（hs-cTnT，≥6 ng/L）和高敏心肌肌钙蛋白I（男性≥6 ng/L，女性≥4 ng/L）升高的年龄标准化患病率分别为26.43%、47.44%和19.23%。在调整心血管和肾脏危险因素后，观察到心脏生物标志物升高与CKD之间存在显著相关性。对随访数据的分析显示，心脏生物标志物升高与全因死亡的累积发生率独立相关（CKD：校正风险比[HR]：NT-proBNP：2.00[95%CI，1.56 - 2.56]；hs-cTnT：2.89[95%CI，1.96 - 4.26]；hs-cTnI：1.92[95%CI，1.50 - 2.44]）以及心血管死亡（CKD：校正风险比[HR]：NT-proBNP：2.38[95%CI，1.61 - 3.51]；hs-cTnT：2.70[95%CI，1.35 - 5.40]；hs-cTnI：2.11[95%CI，1.46 - 3.04]）。此外，不同的检测方法（雅培、西门子、奥瑟）对hs-cTnI与CKD之间的相关性没有显著影响，观察到一致的正相关。我们的研究评估了CKD个体中心脏生物标志物升高的巨大负担，并提供了关于长期死亡风险的关键预后信息。这些发现将为不同人群的风险分层和制定个性化预防策略提供重要指导。
