The Association of Plasma Lactate With Incident Cardiovascular Outcomes
The Association of Plasma Lactate With Incident Cardiovascular Outcomes
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DOI：
10.1093/aje/kwt002
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发表时间：
2013-08-01
影响因子：
5
通讯作者：
Young, J. Hunter
中科院分区：
文献类型：
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作者：
Matsushita, Kunihiro;Williams, Emma K.;Young, J. Hunter
我们在社区动脉粥样硬化风险（ARIC）研究访视4（1996 - 1998）的10，006名参与者中检查了静息时血浆乳酸（氧化能力的标志物）与心血管事件结局的相关性。我们使用考克斯比例风险模型，通过血浆乳酸的四分位数（Q1，5.3 mg/dL; Q2，5.46.6; Q3，6.78.6; Q4，8.7）来估计冠心病、卒中、心力衰竭和全因死亡率的风险比。在10.7年的中位随访时间内，有1，105例冠心病病例，379例中风病例，820例心力衰竭病例和1，408例死亡。在人口统计学校正模型中观察到乳酸水平与心血管事件之间存在显著的分级关系（趋势均P <0.001）。在进一步校正传统和其他潜在混杂因素后，心力衰竭与心功能的相关性仍然显著（Q4与Q1：风险比（HR）1.35，95置信区间（CI）：1.07，1.71）和全因死亡率（HR 1.27，95 CI：1.07，1.51）（这些结局的趋势P <0.02），但冠心病（HR 1.02，95 CI：0.84，1.24）和卒中（HR 1.26，95 CI：0.91，1.75）未发生。在进一步调整N-末端B型利钠肽前体和排除3年内发生心力衰竭的受试者后，多个亚组的心力衰竭结果稳健。血浆乳酸与心力衰竭和全因死亡率的独立相关性表明低静息氧化能力的重要作用。
We examined the association of plasma lactate at rest, a marker of oxidative capacity, with incident cardiovascular outcomes in 10,006 participants in the Atherosclerosis Risk in Communities (ARIC) Study visit 4 (19961998). We used Cox proportional-hazards models to estimate hazard ratios of incident coronary heart disease, stroke, heart failure, and all-cause mortality by quartiles of plasma lactate (Q1, 5.3 mg/dL; Q2, 5.46.6; Q3, 6.78.6; and Q4 8.7). During a median follow-up time of 10.7 years, there were 1,105 coronary heart disease cases, 379 stroke cases, 820 heart failure cases, and 1,408 deaths. A significant graded relation between lactate level and cardiovascular events was observed in the demographically adjusted model (all P for trend 0.001). After further adjustment for traditional and other potential confounders, the association remained significant for heart failure (Q4 vs. Q1: hazard ratio (HR) 1.35, 95 confidence interval (CI): 1.07, 1.71) and all-cause mortality (HR 1.27, 95 CI: 1.07, 1.51) (P for trend 0.02 for these outcomes) but not for coronary heart disease (HR 1.02, 95 CI: 0.84, 1.24) and stroke (HR 1.26, 95 CI: 0.91, 1.75). The results for heart failure were robust across multiple subgroups, after further adjustment for N-terminal proB-type natriuretic peptide and after exclusion of participants with incident heart failure within 3 years. The independent associations of plasma lactate with heart failure and all-cause mortality suggest an important role for low resting oxidative capacity.