Are traditional risk factors valid for assessing cardiovascular risk in end-stage renal failure patients?
Are traditional risk factors valid for assessing cardiovascular risk in end-stage renal failure patients?
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DOI：
10.1111/j.1440-1797.2008.00982.x
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发表时间：
2008-12-01
期刊：
影响因子：
2.5
通讯作者：
Kerr, Peter G.
中科院分区：
文献类型：
--
作者：
Shah, Dibya S.;Polkinghorne, Kevan R.;Kerr, Peter G.
心血管疾病（CVD）是终末期肾功能衰竭（ESRF）发病和死亡的主要原因。建立传统的危险因素是否是有效的预测因素，心血管疾病在ESRF是重要的，以制定预防和干预策略为ESRF population.In这项回顾性队列研究中，一个队列的透析患者进行了检查2000年9月和2001年2月之间。仅纳入基线时无既往CVD事件的受试者。对于每个个体，使用基于Fracheart研究预后算法的新西兰5年CVD风险预测图表计算5年CVD风险。确定每例患者随后5年的CVD结局，并将观察到的首次CVD事件发生率与预测风险进行比较。个体危险因素与心血管疾病结局的关系也进行了评估。在这些患者中，274例基线时没有心血管疾病事件，27%的患者在随后的5年中发生了心血管疾病事件。观察到的CVD风险是预测风险的两倍多，尽管两者之间存在线性相关。在个体风险因素中，年龄增加、糖尿病和吸烟与CVD事件的发生率显著相关，但与一般人群不同的是，收缩压，总胆固醇/高密度脂蛋白比值和体重指数与心血管事件无显著相关性。尿毒症状态中存在的传统危险因素是ESRF患者CVD的独立危险因素。然而，传统心血管风险特征的应用确实允许ESRF人群的风险分层。
Cardiovascular diseases (CVD) are the major cause of morbidity and mortality in end-stage renal failure (ESRF). Establishing whether traditional risk factors are valid predictors of CVD in ESRF is important in order to devise preventive and interventional strategies for the ESRF populations.In this retrospective cohort study, a cohort of patients on dialysis were examined between September 2000 and February 2001. Only those without previous CVD events at baseline were included. For each individual, 5 year CVD risk was calculated using the New Zealand 5 year CVD risk prediction charts based on the Framingham Heart Study prognostic algorithm. The subsequent 5 year CVD outcome for each patient was determined and the observed rate of first CVD events was compared to the predicted risk. Relation of individual risk factors with the CVD outcome was also assessed.Of the patients, 274 were without previous CVD events at baseline and 27% experienced CVD events during the subsequent 5 years. Observed CVD risk was more than twofold that of predicted risk although there was a linear correlation between the two. Among individual risk factors, increasing age, diabetes and smoking were significantly related to the incidence of the CVD events but, unlike in the general population, systolic blood pressure, total cholesterol/high-density lipoprotein ratio and body mass index were not significantly related to CVD events.The very high incidence of CVD in ESRF patients suggest that non-traditional risk factors present in the uraemic state are independent risk factors for CVD in ESRF patients. Nevertheless, the application of traditional cardiovascular risk profiles does allow risk stratification of the ESRF population.