Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals
Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals
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DOI：
10.1001/jama.286.4.421
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发表时间：
2001-07-25
影响因子：
120.7
通讯作者：
Yusuf, S
中科院分区：
文献类型：
--
作者：
Gerstein, HC;Mann, JFE;Yusuf, S
背景：微量白蛋白尿是心血管事件的危险因素。白蛋白尿程度与CV风险之间的关系尚不清楚。目的评估糖尿病（DM）高危个体和无DM且有微量白蛋白尿的个体发生CV事件的风险，并确定低于微量白蛋白尿阈值的白蛋白尿水平是否会增加CV风险。设计心脏结局预防评估研究，一项于1994年至1999年间进行的队列研究，中位随访时间为4.5年。设置北美、南美和欧洲的社区和学术实践。参与者年龄在55岁或以上、有CV疾病史（n=5545）或DM和至少1个CV风险因素（n =3498）和基线尿白蛋白/肌酐比值（ACR）测量。主要结果测量心血管事件（心肌梗死、中风或CV死亡）;全因死亡;充血性心力衰竭住院治疗。微量白蛋白尿增加了主要CV事件（RR，1.83; 95%置信区间[CI]，1.64-2.05）、全因死亡（RR，2.09; 95% CI，1.84-2.38）和因充血性心力衰竭住院（RR，3.23; 95% CI，2.54-4.10）的校正相对风险（RR）。在有或无DM的受试者中观察到相似的RR，即使在调整其他CV风险因素后也是如此（例如，DM受试者主要汇总终点的调整RR为1.97 [95% CI，1.68-2.31]，无DM受试者为1.61 [95% CI，1.36-1.90]）。与ACR的最低四分位数（1.62 mg/mmol）相比（P趋势
Context Microalbuminuria is a risk factor for cardiovascular (CV) events. The relationship between the degree of albuminuria and CV risk is unclear.Objectives To estimate the risk of CV events in high-risk individuals with diabetes mellitus (DM) and without DM who have microalbuminuria and to determine whether levels of albuminuria below the microalbuminuria threshold increase CV risk.Design The Heart Outcomes Prevention Evaluation study, a cohort study conducted between 1994 and 1999 with a median 4.5 years of follow-up.Setting Community and academic practices in North and South America and Europe.Participants Individuals aged 55 years or more with a history of CV disease (n=5545) or DM and at least 1 CV risk factor (n =3498) and a baseline urine albumin/creatinine ratio (ACR) measurement.Main Outcome Measures Cardiovascular events (myocardial infarction, stroke, or CV death); all-cause death; and hospitalization for congestive heart failure.Results Microalbuminuria was detected in 1140 (32.6%) of those with DM and 823 (14.8%) of those without DM at baseline. Microalbuminuria increased the adjusted relative risk (RR) of major CV events (RR, 1.83; 95% confidence interval [CI], 1.64-2.05), all-cause death (RR, 2.09; 95% CI, 1.84-2.38), and hospitalization for congestive heart failure (RR, 3.23; 95% CI, 2.54-4.10). Similar RRs were seen for participants with or without DM, even after adjusting for other CV risk factors (eg, the adjusted RR of the primary aggregate end point was 1.97 [95% CI, 1.68-2.31] in those with DM and 1.61 [95% CI, 1.36-1.90] in those without DM). Compared with the lowest quartile of ACR (1.62 mg/mmol) (P for trend