Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study
Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study
复制标题
DOI：
10.2215/cjn.13111215
复制
发表时间：
2016-08-01
影响因子：
9.8
通讯作者：
Young, Bessie
中科院分区：
文献类型：
--
作者：
Afkarian, Maryam;Katz, Ronit;Young, Bessie
背景和目的黑人心血管疾病的发病率和死亡率高。糖尿病和慢性肾脏病是普通人群心血管死亡的危险因素，在黑人中很常见。我们试图评估他们的贡献，心血管疾病和死亡率在blacks.Design，设置，参与者和测量这项观察性队列研究是3211名参与者的杰克逊心脏研究（2000年至2004年注册）。量化了糖尿病、慢性肾脏病（CKD）和糖尿病患者的卒中发病率、冠心病发病率和心血管死亡率。（eGFR <60 ml/min/1.73 m2，尿白蛋白/肌酐比值>= 30 mg/g，或两者兼有），或两者兼有，直至2012年，中位随访时间为6.99年。（14.2%）的参与者仅患有糖尿病，257（8.0%）仅患有CKD，201（6.3%）两者都有，2297（71.5%）两者都没有。在调整人口统计学和临床协变量（包括流行性心血管疾病）后，无CKD的糖尿病与卒中、冠心病和心血管死亡的额外风险相关（超额发生率，2.6; 95%置信区间，0.5至4.7; 2.6; 95%置信区间，0.3至4.8;和2.4; 95%置信区间，分别为0.4 - 4.3/1000人-年）。无糖尿病的慢性肾脏病与中风和冠心病的非显著性额外风险相关（分别为2.5; 95%置信区间，-0.1至5.2和2.4; 95%置信区间，-0.8至5.5/1000人-年），但心血管死亡率的超额风险更大（7.3; 95%置信区间，3.0 - 11.5/1000人-年）。糖尿病和慢性肾脏病一起与更大的额外中风风险相关（13.8; 95%置信区间，5.3 - 22.3/1000人-年），冠心病（12.8; 95%置信区间，4.9 - 20.8/1000人-年）和心血管死亡率（14.8; 95%置信区间，7.2 - 22.3/1000人-年）。与糖尿病和CKD的组合相关的超额风险大于与已建立的危险因素，包括流行的心血管疾病，结论糖尿病和肾脏疾病的组合与黑人的心血管事件和死亡率的大量超额风险。
Background and objectives Blacks have high rates of cardiovascular disease and mortality. Diabetes and CKD, risk factors for cardiovascular mortality in the general population, are common among blacks. We sought to assess their contribution to cardiovascular disease and mortality in blacks.Design, setting, participants, & measurements This observational cohort study was of 3211 participants in the Jackson Heart Study (enrolled 2000-2004). Rates of incident stroke, incident coronary heart disease, and cardiovascular mortality were quantified in participants with diabetes, CKD (eGFR < 60 ml/min per 1.73 m(2), urine albumin-to-creatinine ratio >= 30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years.Results Four hundred fifty-six (14.2%) participants had only diabetes, 257 (8.0%) had only CKD, 201 (6.3%) had both, and 2297 (71.5%) had neither. Diabetes without CKD was associated with excess risks of incident stroke, incident coronary heart disease, and cardiovascular mortality after adjustment for demographic and clinical covariates, including prevalent cardiovascular disease (excess incidence rates, 2.6; 95% confidence interval, 0.5 to 4.7; 2.6; 95% confidence interval, 0.3 to 4.8; and 2.4; 95% confidence interval, 0.4 to 4.3 per 1000 person-years, respectively). CKD without diabetes was associated with comparable nonsignificant excess risks for incident stroke and coronary heart disease (2.5; 95% confidence interval, -0.1 to 5.2 and 2.4; 95% confidence interval, -0.8 to 5.5 per 1000 person-years, respectively) but a larger excess risk for cardiovascular mortality (7.3; 95% confidence interval, 3.0 to 11.5 per 1000 person-years). Diabetes and CKD together were associated with greater excess risks for incident stroke (13.8; 95% confidence interval, 5.3 to 22.3 per 1000 person-years), coronary heart disease (12.8; 95% confidence interval, 4.9 to 20.8 per 1000 person-years), and cardiovascular mortality (14.8; 95% confidence interval, 7.2 to 22.3 per 1000 person-years). The excess risks associated with the combination of diabetes and CKD were larger than those associated with established risk factors, including prevalent cardiovascular disease.Conclusions The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.