Effect of aggressive risk factor modification on cardiac events and myocardial ischaemia in patients with chronic kidney disease
Effect of aggressive risk factor modification on cardiac events and myocardial ischaemia in patients with chronic kidney disease
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DOI：
10.1136/hrt.2005.074393
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发表时间：
2006-10-01
期刊：
影响因子：
5.7
通讯作者：
Isbel, N. M.
中科院分区：
文献类型：
--
作者：
Rakhit, D. J.;Marwick, T. H.;Isbel, N. M.
目的：探讨积极的危险因素干预在慢性肾脏病(CKD)中是否能够限制新的缺血的发展或减少心脏事件。方法：将CKD患者随机分为积极危险因素干预策略(针对高血压、血脂异常、同型半胱氨酸、血红蛋白和磷酸盐的靶向治疗)和标准护理。对152名接受了基线多巴酚丁胺负荷超声心动图(DSE)的患者进行了意向处理分析，其中107名患者进行了随访。基线时记录生化指标、心脏危险因素和检查(心电图、二维超声心动图)。在随访和基线DSE之间，新的缺血被归类为新的或恶化的应力性室壁运动异常。结果：新的心肌缺血的发生在标准治疗组和积极治疗组之间是常见的，但没有差异(15(21%)vs18(23%)，p=0.8)。新的脑缺血的独立预测因素是高龄、异常的心电图、较高的收缩压和较低的血清高密度脂蛋白胆固醇，但不是治疗组。标准治疗组和积极治疗组在心脏事件发生率(10%vs13%，p=0.6)或全因死亡率(10%vs19%，p=0.2)方面没有差异。在基线DSE异常(非诊断性、疤痕或缺血)的患者中，事件发生率相似(22%对20%，p=0.9)。结论：积极调整CKD的危险因素并不能限制新的缺血的发展或减少DSE异常患者的心脏事件。
Objective: To examine whether aggressive risk factor modification in chronic kidney disease (CKD) can limit the development of new ischaemia or reduce cardiac events.Methods: Patients with CKD were randomly assigned to either an aggressive risk factor modification strategy (targeted treatment of hypertension, dyslipidaemia, homocysteine, haemoglobin and phosphate) or standard care. An intention to treat analysis was performed on 152 patients who had baseline dobutamine stress echocardiography (DSE), including 107 who had follow-up DSE. Biochemical parameters, cardiac risk factors and investigations (ECG, two-dimensional echocardiography) were recorded at baseline. New ischaemia was classed as new or worsening stress wall motion abnormality between follow-up and baseline DSE. Patients were followed up for the development of new ischaemia or cardiac death, acute coronary syndrome and non-fatal myocardial infarction over 1.8 years.Results: The development of new ischaemia was common but not different between the standard and aggressively treated groups ( 15 (21%) v 18 (23%), p = 0.8). Independent predictors of new ischaemia were older age, abnormal ECG, higher systolic blood pressure and lower serum high density lipoprotein cholesterol, but not treatment arm. The standard and aggressively treated groups did not differ in cardiac event rate (10% v 13%, p = 0.6) or all-cause mortality ( 10% v 19%, p = 0.2). In patients with an abnormal baseline DSE (non-diagnostic, scar or ischaemia), the event rate was similar (22% v 20%, p = 0.9).Conclusion: Aggressive risk factor modification in CKD does not limit the development of new ischaemia or reduce cardiac events in patients with an abnormal DSE.