Additive Interaction of Metabolic Syndrome and Chronic Kidney Disease on Cardiac Hypertrophy, and Risk of Cardiovascular Disease in Hypertension
Additive Interaction of Metabolic Syndrome and Chronic Kidney Disease on Cardiac Hypertrophy, and Risk of Cardiovascular Disease in Hypertension
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DOI：
10.1038/ajh.2009.253
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发表时间：
2010-03-01
影响因子：
3.2
通讯作者：
Kawano, Yuhei
中科院分区：
文献类型：
--
作者：
Iwashima, Yoshio;Horio, Takeshi;Kawano, Yuhei
背景：最近的流行病学分析表明代谢综合征(METS)与慢性肾脏疾病(CKD)之间存在联系。方法共1160例高血压患者(平均年龄63岁，男性53%)接受了临床评估、实验室检查和多普勒超声心动图检查，并进行了平均4.8年的随访期监测。结果根据有无METS和/或CKD，受试者分为四组，与无METS和/或CKD组比较(METS(-)/CKD-)；合并Mets和CKD(Mets(+)/CKD+)的患者发生LVH的多因素调整优势比为2 40(95%可信区间(CI)1 66~3 48)。在随访期内，172名受试者进行了包括左心室重量指数(LVMI)在内的多因素Cox回归分析，结果显示MET和CKD的存在均是CVD的独立预测因素(危险比：MET为190，CKD为1.82)。然后我们将全部受试者分成四组，发现与Mets(-)/CKD-组相比，Mets(+)/CKD+组的多变量调整HR为3.58(95%CI 2.14-5.95)。结论研究结果表明，在高血压患者中，Mets和CKD的组合是LVH的强烈危险因素，也是随后CVD的强大和独立的预测因子。这些发现突显了甲硫氨酸和慢性肾脏病在高血压中同时存在的临床重要性。
BACKGROUNDRecent epidemiologic analyses have demonstrated a link between the metabolic syndrome (MetS) and chronic kidney disease (CKD). We examined the association between MetS, CKD, and left ventricular hypertrophy (LVH), and prospectively investigated the predictive value of the combination of MetS and CKD for cardiovascular disease (CVD) in essential hypertensionMETHODSA total of 1,160 essential hypertensive patients (mean age 63 years, 53% male) underwent clinical evaluation, laboratory testing, and Doppler echocardiography, and were monitored for a mean follow-up of 4.8 yearsRESULTSAt baseline, total subjects were divided into four groups according to the presence/absence of MetS and/or CKD, and, compared to the group without MetS and CKD (MetS(-)/CKD-); those with MetS and CKD (MetS(+)/CKD+) had a multivariate-adjusted odds ratio of 2 40 (95% confidence interval (Cl) 1 66-3 48) for LVH. During the follow-up period, 172 subjects developed CVD Multiple Cox regression analysis including LV mass index (LVMI) showed that the presence of MetS as well as that of CKD were each independent predictors of CVD (hazard ratio 190 for MetS, 1.82 for CKD). We then divided the total subjects into four groups, and found that, compared to the MetS(-)/CKD- group, multivariate-adjusted HR for the MetS(+)/CKD+ group was 3 58 (95% Cl 2.14-5 95)CONCLUSIONSOur findings suggest that, in essential hypertension, the combination of MetS and CKD is a strong risk for LVH as well as a strong and independent predictor of subsequent CVD. These findings highlight the clinical importance of the concomitance of MetS and CKD in essential hypertension