Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects -: Five-year follow-up of the Hoorn study
Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects -: Five-year follow-up of the Hoorn study
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DOI：
10.1161/01.atv.19.3.617
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发表时间：
1999-03-01
影响因子：
8.7
通讯作者：
Stehouwer, CDA
中科院分区：
文献类型：
--
作者：
Jager, A;Kostense, PJ;Stehouwer, CDA
微量白蛋白尿（MA）与心血管和全因死亡率增加有关。有人提出MA反映了全身性动脉粥样硬化，因此可以预测死亡率。为了验证这一假设，我们一方面研究了MA与外周动脉疾病（PAD）（一种公认的广泛性动脉粥样硬化的标志物）之间的关系，另一方面研究了年龄、性别和葡萄糖耐量分层样本（n = 631）之间的关系，这些样本来自一个年龄在50至75岁的人群队列，前瞻性随访5年。基线时，白蛋白与肌酐比值（ACR）在夜间尿样中测量；MA定义为ACR >2.0 mg/mmol。PAD定义为踝肱压指数低于0.90和/或有外周动脉搭桥或截肢史。经过5年的随访，58名受试者死亡（24人死于心血管疾病）。MA和PAD均与心血管死亡率增加4倍相关。在调整了年龄、性别、糖尿病、高血压、总胆固醇、高密度脂蛋白胆固醇和甘油三酯水平、体重指数、吸烟习惯和先前存在的缺血性心脏病后，MA的相对危险度（RR）（95%置信区间）为3.2(1.3至8.1)，PAD的相对危险度（RR）为2.4（0.9至6.1）。当MA和PAD都纳入多变量分析时，MA的rr为2.9 (1.1 - 7.3)，PAD的rr为2.0（0.7 - 5.7）。MA和PAD均与全因死亡率增加约2倍相关。高血压患者与MA和PAD相关的全因死亡率比正常受试者高4倍左右。我们得出结论，MA和PAD都与心血管死亡风险增加有关。MA和PAD是相互独立的风险指标。MA和PAD与全因死亡率的相关性较弱。它们在有高血压时比没有高血压时更明显。这些数据表明，动脉粥样硬化影响死亡风险的机制不同于全身性动脉粥样硬化。
Microalbuminuria (MA) is associated with increased cardiovascular and all-cause mortality. It has been proposed that MA reflects generalized atherosclerosis and may thus predict mortality. To investigate this hypothesis, we studied the associations between, on the one hand, MA and peripheral arterial disease (PAD), a generally accepted marker of generalized atherosclerosis, and, on the other hand, cardiovascular and all-cause mortality in an age-, sex-, and glucose tolerance-stratified sample (n = 631) of a population-based cohort aged 50 to 75 years followed prospectively for 5 years. At baseline, the albumin-to-creatinine ratio (ACR) was measured in an overnight spot urine sample; MA was defined as ACR >2.0 mg/mmol. PAD was defined as an ankle-brachial pressure index below 0.90 and/or a history of a peripheral arterial bypass or amputation. After 5 years of follow-up, 58 subjects had died (24 of cardiovascular causes). Both MA and PAD were associated with a 4-fold increase in cardiovascular mortality. After adjusting for age, sex, diabetes mellitus, hypertension, levels of total and HDL-cholesterol and triglyceride, body mass index, smoking habits, and preexistent ischemic heart disease, the relative risks (RR) (95% confidence intervals) were 3.2 (1.3 to 8.1) for MA and 2.4 (0.9 to 6.1) for PAD. When both MA and PAD were included in the multivariate analysis, the RRs were 2.9 (1.1 to 7.3) for MA and 2.0 (0.7 to 5.7) for PAD. MA and PAD were both associated with an about 2-fold increase in all-cause mortality. The RRs of all-cause mortality associated with MA and PAD were about 4 times higher among hypertensive than among normotensive subjects. We conclude that both MA and PAD are associated with an increased risk of cardiovascular mortality. MA and PAD are mutually independent risk indicators. The associations of MA and PAD with all-cause mortality are somewhat weaker. They are more pronounced in the presence of hypertension than in its absence. These data suggest that MA affects mortality risk through a mechanism different from generalized atherosclerosis.