Association Between Coronary Artery Calcification Progression and Microalbuminuria The MESA Study
Association Between Coronary Artery Calcification Progression and Microalbuminuria The MESA Study
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DOI：
10.1016/j.jcmg.2010.01.008
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发表时间：
2010-06-01
影响因子：
14
通讯作者：
Nasir, Khurram
中科院分区：
文献类型：
--
作者：
DeFilippis, Andrew P.;Kramer, Holly J.;Nasir, Khurram
本研究试图通过冠状动脉钙化（CAC）的发生和进展来评估微量白蛋白尿（MA）与动脉粥样硬化的发展和进展之间的关系。但MA增加这种风险的机制尚不清楚。（动脉粥样硬化的多种族研究）研究是一项前瞻性队列研究，纳入了6，814名自认为在入组时无临床心血管疾病的白色、非裔美国人、西班牙裔或中国受试者。在6,775名有尿白蛋白数据的受试者中，我们排除了97名有大量白蛋白尿的受试者和1,023名随访CAC数据缺失的受试者。结果在基线时，MA患者的CAC >0的可能性高于非MA患者（62%对48%，p < 0.0001）。在平均2.4 ± 0.8年的随访中，在人口统计学校正分析中，与无MA的患者相比，基线时有MA且无CAC的患者更容易发生CAC（相对风险[RR]：2.05，95%置信区间[CI]：1.41 - 3.02，p < 0.0001）。多变量校正后，相关性减弱，但仍具有统计学显著性（RR：1.76，95% CI：1.19至2.61，p = 0.005）。在基线时有CAC的患者中，在人口统计学调整分析中，有MA的患者与无MA的患者相比，CAC的中位数增加高15（95% CI：8至22，p < 0.0001）个体积单位。多变量调整后，MA仍与CAC事件相关（RR：1.76，95% CI：1.19至2.61，p = 0.005）和CAC进展（CAC体积评分中位增加9 [95% CI：2至16，p = 0.009]），相对于那些没有MA。一项基于人群的无症状个体研究表明，MA患者发生CAC的风险增加，CAC进展也更快。需要进一步的研究来确定MA先于和预测动脉粥样硬化进展的程度，以及如何利用这些信息来减少心血管事件。（美国科尔心脏病学杂志2010; 3：595-604）（C）美国心脏病学会基金会2010年
OBJECTIVES This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC).BACKGROUND MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known.METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects.RESULTS At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62% vs. 48%, p < 0.0001). During a mean follow-up of 2.4 +/- 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95% confidence interval [CI]: 1.41 to 3.02, p < 0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95% CI: 8 to 22, p < 0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95% CI: 2 to 16, p = 0.009]), relative to those without MA.CONCLUSIONS This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events. (J Am Coll Cardiol Img 2010; 3: 595-604) (C) 2010 by the American College of Cardiology Foundation