Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients
Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients
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DOI：
10.1046/j.1523-1755.2000.00173.x
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发表时间：
2000-07-01
影响因子：
19.6
通讯作者：
Levey, AS
中科院分区：
文献类型：
--
作者：
Cheung, AK;Sarnak, MJ;Levey, AS
背景资料。心血管疾病是慢性血液透析患者最常见的死亡原因，但这些事件的危险因素尚未很好地确定。在这项横断面研究中，我们调查了936名血液透析患者中几种传统的心血管疾病危险因素与心血管事件的存在或病史之间的关系，这些患者参加了由美国国立卫生研究院赞助的血液透析研究的基线阶段。使用多变量Logistic回归模型估计每个选定危险因素的调整优势比：控制剩余危险因素、临床中心和透析年限。40%的患者患有冠心病。19%的人患有脑血管疾病，23%的人患有外周血管疾病。正如预期的那样，糖尿病和吸烟与心血管疾病密切相关。年龄的增加也是一个重要的因素，特别是在55岁以下的人群和非糖尿病患者中。与非黑人相比，黑人种族患心血管疾病的风险更低。有趣的是，血清总胆固醇和透析前收缩压均与冠心病、脑血管疾病或外周血管疾病无关。使用Framingham推论积分对我们队列中的冠状动脉风险进行进一步评估表明，传统的危险因素不足以预测血液透析患者的冠心病。在这项横断面研究中，普通人群中的一些传统冠状动脉危险因素似乎也适用于血液透析人群，而其他因素确实与动脉粥样硬化性心血管疾病相关。非传统的危险因素，包括尿毒症的环境，也许还有血液透析程序本身，都可能起到作用。需要进一步的研究来确定心血管危险因素，以便为慢性血液透析人群制定预防和干预策略。
Background. Cardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established.Methods. In this cross-sectional study, we examined the relationship between several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled in the baseline phase of the Hemodialysis Study sponsored by the U.S. National Institutes of Health. The adjusted odds ratios for each of the selected risk factors were estimated using a multivariable: logistic regression model, controlling for the remaining risk factors, clinical center, and years on dialysis.Results. Forty percent of the patients had coronary heart disease. Nineteen percent had cerebrovascular disease, and 23% had peripheral vascular disease. As expected, diabetes and smoking were strongly associated with cardiovascular diseases. Increasing age was also an important contributor, especially in the group less than 55 years and in nondiabetic patients. Black race was associated with a lower risk of cardiovascular diseases than non-blacks. Interestingly, neither serum total cholesterol nor predialysis systolic blood pressure was associated with coronary heart disease, cerebrovascular disease, or peripheral vascular disease. Further estimation of the coronary risks in our cohort using the Framingham corollary point score suggests that traditional risk factors ale inadequate predictors of coronary heart disease in hemodialysis patients.Conclusions. Some of the traditional coronary risk factors in the general population appear to be also applicable to the hemodialysis population, while other factors did nut correlate with atherosclerotic cardiovascular diseases in this cross-sectional study. Nontraditional risk factors, including the uremic milieu and perhaps the hemodialysis procedure itself, are likely to be contributory. Further studies are necessary to define the cardiovascular risk factors in order to devise preventive and interventional strategies For the chronic hemodialysis population.