Explained and unexplained ischemic heart disease risk after renal transplantation
Explained and unexplained ischemic heart disease risk after renal transplantation
复制标题
DOI：
10.1681/asn.v1191735
复制
发表时间：
2000-09-01
影响因子：
13.6
通讯作者：
Roel, J
中科院分区：
文献类型：
--
作者：
Kasiske, BL;Chakkera, HA;Roel, J
肾移植患者中缺血性心脏病（IHD）的高发病率是否可以归因于普通人群中已发现的相同危险因素尚不清楚。通过使用弗雷明汉心脏研究 (FHS) 计算的风险来估计 1124 名移植受者在移植后 1 年以上发生重大 IHD 事件的风险。 FHS 风险预测 IHD（相对风险，1.28；95% 置信区间，1.20 至 1.40；P < 0.001）；然而，FHS 风险往往低估了肾移植受者发生 IHD 的风险。这主要归因于与糖尿病相关的风险增加，以及肾移植受者的年龄和吸烟（较小程度上）。对于男性来说，移植受者和 FHS 人群患糖尿病的相对风险分别为 2.78（1.73 至 4.49）和 1.53；年龄（以岁为单位）的相对风险分别为1.06（1.04至1.08）和1.05，吸烟的相对风险分别为1.95（1.20至3.19）和1.69。对于女性来说，患糖尿病的相对风险分别为 5.40（2.73 至 10.66）和 1.82。与 FHS 人群相比，移植受者与胆固醇水平相关的风险有较高的趋势，但与高密度脂蛋白胆固醇水平和血压相关的风险似乎相当。独立于这些和其他风险因素，移植受者人群的 IHD 调整后风险有所降低。与1986年之前的时代相比，1986年至1992年间移植的相对风险较低，为0.60（0.39至0.92）； 1992 年之后的移植与 IHD 的相对风险更低，为 0.27（0.11 至 0.63）。值得关注的是，二氢吡啶钙通道拮抗剂与 IHD 风险增加相关（相对风险，2.26；95% 置信区间，1.24 至 4.12；P = 0.008），并且这种关联独立于其他抗高血压药物和危险因素。因此，尽管FHS风险可以预测肾移植后IHD，但它往往会低估风险，尤其是与糖尿病相关的风险。二氢吡啶钙通道拮抗剂与 IHD 风险增加相关这一意外发现值得进一步评估。
Whether the high incidence of ischemic heart disease (IHD) among renal transplant patients can be attributed to the same risk factors that have been identified in the general population is unclear. The risk for major IHD events occurring >1 yr after transplantation among 1124 transplant recipients was estimated by using the risk calculated from the Framingham Heart Study (FHS). The FHS risk predicted IHD (relative risk, 1.28; 95% confidence interval, 1.20 to 1.40; P < 0.001); however, the FHS risk tended to underestimate the risk of IHD for renal transplant recipients. This was largely attributable to increased risks associated with diabetes mellitus and, to a lesser extent, age and cigarette smoking for renal transplant recipients. For men, the relative risks for diabetes mellitus were 2.78 (1.73 to 4.49) and 1.53 for the transplant recipient and FHS populations, respectively; the relative risks for age (in years) were 1.06 (1.04 to 1.08) and 1.05, respectively, and those for smoking were 1.95 (1.20 to 3.19) and 1.69, respectively. For women, the relative risks for diabetes mellitus were 5.40 (2.73 to 10.66) and 1.82, respectively. There was a tendency for the risk associated with cholesterol levels to be higher for transplant recipients, compared with the FHS population, but the risks associated with high-density lipoprotein cholesterol levels and BP appeared to be comparable. Independent of these and other risk factors, the adjusted risk of IHD for the transplant recipient population has decreased. Compared with the era before 1986, transplantation between 1986 and 1992 was associated with a lower relative risk of 0.60 (0.39 to 0.92); transplantation after 1992 was associated with an even lower relative risk of 0.27 (0.11 to 0.63) for IHD. Of concern was the fact that dihydropyridine calcium channel antagonists were associated with an increased risk for IHD (relative risk, 2.26; 95% confidence interval, 1.24 to 4.12; P = 0.008), and this association was independent of other antihypertensive agents and risk factors. Therefore, although the FHS risk predicts IHD after renal transplantation, it tends to underestimate the risks, especially the risk associated with diabetes mellitus. The unexpected finding that dihydropyridine calcium channel antagonists were associated with an increased IHD risk merits further evaluation.