Associations between renovascular disease and prevalent cardiovascular disease in the elderly: a population-based study.
Associations between renovascular disease and prevalent cardiovascular disease in the elderly: a population-based study.
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DOI：
10.1177/153857440403800103
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发表时间：
2004-01-01
影响因子：
0.9
通讯作者：
Dean, Richard H
中科院分区：
文献类型：
--
作者：
Edwards, Matthew S;Hansen, Kimberley J;Dean, Richard H
动脉粥样硬化性肾血管病（RVD）通过其对血压和排泄肾功能的潜在影响以及通过其与其他形式的心血管疾病（CVD）的相关性，被怀疑是心血管疾病（CVD）发病率和死亡率的贡献者。然而，基于人群的数据之间的关联RVD的存在和流行的CVD是缺乏的。心血管健康研究（CHS）是一项针对美国老年人心血管疾病的前瞻性、多中心队列研究。作为辅助研究的一部分，邀请北卡罗来纳州福赛斯县CHS队列的参与者接受肾脏双功超声检查（RDS），以确定是否存在RVD（定义为任何局灶性收缩期峰值速度>/= 1.8 m/s或成像动脉无多普勒频移信号）。从CHS协调中心获得人口统计学、危险因素和普遍CVD数据，并与辅助研究参与者进行匹配。834名CHS参与者（包括525名女性[63%]，309名男性[37%]，194名非洲裔美国人[23%]和635名白人[76%]）接受了RDS检查，平均年龄为77.2 ± 4.9岁。57例受试者（6.8%）存在RVD。总体而言，603名参与者（72.3%）在RDS时存在CVD的临床和/或亚临床表现。患有RVD的受试者表现出心绞痛（p = 0.002）、既往心肌梗死（p < 0.001）、颈内动脉直径缩小≥ 25%狭窄（p = 0.010）、颈动脉内膜中层厚度增加（p = 0.003）和主要心电图异常（p = 0.013）的患病率显著更高。在调整人口统计学和心血管危险因素后，RVD的存在与冠状动脉疾病的患病率有显著的独立相关性，但与脑血管疾病或下肢血管疾病的患病率无关。这些结果表明，RVD与CVD的临床和亚临床表现，特别是冠状动脉疾病之间存在重要的基于人群的关联。
Atherosclerotic renovascular disease (RVD) is a suspected contributor to the morbidity and mortality of cardiovascular disease (CVD) through its potential effects on blood pressure and excretory renal function as well as through its associations with other forms of CVD. However, population-based data regarding the associations between the presence of RVD and prevalent CVD are lacking. The Cardiovascular Health Study (CHS) is a prospective, multicenter cohort study of CVD among elderly Americans. As part of an ancillary study, participants in the Forsyth County, North Carolina, cohort of the CHS were invited to undergo renal duplex sonography (RDS) to establish the presence or absence of RVD (defined as any focal peak systolic velocity >/= 1.8 m/second or the absence of a Doppler-shifted signal from an imaged artery). Demographic, risk factor, and prevalent CVD data were obtained from the CHS coordinating center and matched with ancillary study participants. Eight hundred thirty-four CHS participants (including 525 women [63%], 309 men [37%], 194 African-Americans [23%], and 635 Caucasians [76%]) with a mean age of 77.2 +/-4.9 years underwent RDS examination. RVD was present in 57 participants (6.8%). Overall, clinical and/or subclinical manifestations of CVD were present in 603 participants (72.3%) at the time of RDS. Participants with RVD demonstrated a significantly greater prevalence of angina (p = 0.002), previous myocardial infarction (p < 0.001), >/= 25% diameter-reducing internal carotid artery stenosis (p = 0.010), increased carotid intimal medial thickness (p = 0.003), and major electrocardiographic abnormalities (p = 0.013). Following adjustment for demographics and cardiovascular risk factors, the presence of RVD demonstrated a significant and independent association with prevalent coronary artery disease but not with prevalent cerebrovascular or lower extremity vascular disease. These results suggest important population-based associations between RVD and both clinical and subclinical manifestations of CVD, especially coronary artery disease.