Adverse effects of left ventricular hypertrophy in the reduction of endpoints in NIDDM with the angiotensin II antagonist losartan (RENAAL) study
Adverse effects of left ventricular hypertrophy in the reduction of endpoints in NIDDM with the angiotensin II antagonist losartan (RENAAL) study
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DOI：
10.1007/s00125-005-1893-1
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发表时间：
2005-10-01
期刊：
影响因子：
8.2
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Boner, G;Cooper, ME;Parving, HH
目的/假设：我们通过血管紧张素II拮抗剂氯沙坦(RENAAL)降低NIDDM终点的试验，在1513名患者中探讨了基线左心室肥厚(LVH)和氯沙坦治疗对肾脏和心血管(CV)事件的影响，该试验研究了氯沙坦对2型糖尿病和肾病患者肾脏疾病进展和/或死亡的影响。材料和方法：采用心电图标准(Cornell乘积和/或Sokolow-Lyon电压)评价左心室肥厚。肾脏或心血管事件的风险由与治疗分配和是否存在左心室肥厚相匹配的比例风险模型确定。基线时的协变量包括年龄、性别、收缩压、平均动脉压、脉搏、蛋白尿、血肌酐、白蛋白和血红蛋白。结果：基线时共有187名受试者(12%)有左室肥厚。使用氯沙坦治疗后，康奈尔乘积(-6.2%)和索科洛-里昂电压(-6.3%)显著降低。研究显示，左心室肥厚与主要终点显著相关，主要终点包括血肌酐增加一倍、终末期肾病或死亡(风险比[HR]=1.44，p=0.011)，以及DSCr/终末期肾病(HR=1.42，p=0.031)和心血管事件(HR=1.68，p=0.001)。使用氯沙坦治疗有左室肥厚的患者，可将心血管事件和肾脏风险降低到与无左室肥厚患者相似的水平。结论/解释：在2型糖尿病和肾病患者中，左心室肥厚与心血管事件和肾脏疾病进展的风险显著增加有关。重要的是，在有左室肥厚的患者中，氯沙坦将心血管疾病和肾脏风险降低到与无左室肥厚患者相似的水平。
Aims/hypothesis: We explored the impact of baseline left ventricular hypertrophy (LVH) and losartan treatment on renal and cardiovascular (CV) events in 1,513 patients from the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) trial, which studied the effects of losartan on the progression of renal disease and/or death in patients with type 2 diabetes and nephropathy. Materials and methods: LVH was assessed using ECG criteria (Cornell product and/or Sokolow-Lyon voltage). The risk of renal or CV events was determined by a proportional hazards model fit with treatment allocation and presence of LVH. Covariates at baseline included age, sex, systolic BP, mean arterial pressure, pulse, proteinuria, serum creatinine, albumin and haemoglobin. Results: A total of 187 subjects (12%) had LVH at baseline. Treatment with losartan resulted in a significant decrease in the Cornell product (-6.2%) and Sokolow-Lyon voltage (-6.3%). LVH was shown to be significantly associated with the primary endpoint, which was a composite of doubling of serum creatinine (DSCR), endstage renal disease (ESRD) or death (hazard ratio [HR]=1.44, p=0.011), as well as with the composite renal endpoint of DSCR/ESRD (HR=1.42, p=0.031) and CV events (HR=1.68, p=0.001). Losartan treatment of patients with LVH decreased the CV as well as renal risk to a level similar to that of patients without LVH. Conclusions/interpretation: In patients with type 2 diabetes and nephropathy, LVH is associated with significantly increased risk of CV events and the progression of kidney disease. Importantly, in patients with LVH, losartan reduced the CV as well as the renal risk to a level similar to that seen in subjects without LVH.