Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease.
Coronary Artery Calcification and Risk of Cardiovascular Disease and Death Among Patients With Chronic Kidney Disease.
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DOI：
10.1001/jamacardio.2017.0363
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发表时间：
2017-06-01
期刊：
影响因子：
24
通讯作者：
CRIC Investigators
中科院分区：
文献类型：
--
作者：
Chen J;Budoff MJ;Reilly MP;Yang W;Rosas SE;Rahman M;Zhang X;Roy JA;Lustigova E;Nessel L;Ford V;Raj D;Porter AC;Soliman EZ;Wright JT Jr;Wolf M;He J;CRIC Investigators
冠状动脉钙化（CAC）在透析前慢性肾病（CKD）患者中非常普遍。然而，关于 CAC 与该人群随后的心血管疾病 (CVD) 风险和全因死亡率之间关系的数据很少。研究 CAC 与透析前 CKD 患者的 CVD 风险和全因死亡率的前瞻性关联。慢性肾功能不全队列研究从美国七个临床中心招募了年龄为 21-74 岁、估计肾小球滤过率 (eGFR) 为 20-70 mL/min/1.73 m2 的成年人。其中，1,541 名基线时没有 CVD、但进行了 CAC 测量的参与者被纳入当前分析中。 CAC 通过电子束计算机断层扫描或多探测器计算机断层扫描进行评估。每六个月报告一次心血管疾病（包括心肌梗死、心力衰竭和中风）的发病率和全因死亡率，并通过病历裁决进行确认。在平均 5.9 年的随访期间，我们观察到 188 例 CVD（60 例心肌梗死、120 例心力衰竭和 27 例中风）和 137 例死亡。在根据年龄、性别、种族、临床部位、教育、体力活动、总胆固醇、HDL-胆固醇、收缩压、抗高血压治疗、当前吸烟、糖尿病、体重指数、C反应蛋白、糖化血红蛋白、磷酸盐、肌钙蛋白T、log-N-末端B型利钠肽、成纤维细胞生长因子-23、eGFR和蛋白尿进行调整的Cox比例风险模型中，与 CAC 的一个标准差相关的风险比（95% 置信区间 [CI]）对于 CVD 为 1.40（1.16 至 1.69，p<.001），对于心肌梗塞为 1.44（1.02 至 2.02，p=.04），对于心力衰竭为 1.39（1.10 至 1.76，p=.006），对于 1.19全因死亡率（0.94 至 1.51，p=.15）。此外，与所有上述已确定的和新的 CVD 危险因素相比，纳入 CAC 评分导致预测 CVD 的 c 统计量显着增加 0.02（95% CI 0.00 至 0.09，p<.001）。 CAC与CKD患者的CVD、心肌梗死和心力衰竭的风险独立且显着相关。此外，与 CKD 患者中已确定的和新的 CVD 危险因素相比，CAC 改善了 CVD、心肌梗塞和心力衰竭的风险预测，尽管 c 统计量的变化很小。
Coronary artery calcification (CAC) is highly prevalent in patients with pre-dialysis chronic kidney disease (CKD). However, there are sparse data on the association of CAC with subsequent risk of cardiovascular disease (CVD) and all-cause mortality in this population. To study the prospective association of CAC with risk of CVD and all-cause mortality among patients with pre-dialysis CKD. Chronic Renal Insufficiency Cohort study recruited adults aged 21–74 years with an estimated-glomerular filtration rate (eGFR) of 20–70 mL/min/1.73 m2 from seven clinical centers in the US. Of them, 1,541 participants without CVD at baseline who had CAC measures were included in current analyses. CAC was assessed by electron-beam computed tomography or multi-detector computed tomography. Incidence of CVD (including myocardial infarction, heart failure, and stroke) and all-cause mortality were reported every six months and confirmed by medical record adjudication. During an average of 5.9 years of follow-up, we observed 188 CVD (60 myocardial infarction, 120 heart failure, and 27 stroke) and 137 deaths. In Cox proportional hazards models adjusted for age, gender, race, clinical site, education, physical activity, total cholesterol, HDL-cholesterol, systolic blood pressure, antihypertensive treatment, current cigarette smoking, diabetes, body-mass index, C-reactive protein, hemoglobin A1c, phosphate, troponin T, log-N-terminal pro-B-type natriuretic peptide, fibroblast growth factor-23, eGFR, and proteinuria, the hazard ratios (95% confidence interval [CI]) associated with one standard deviation of CAC were 1.40 (1.16 to 1.69, p<.001) for CVD, 1.44 (1.02 to 2.02, p=.04) for myocardial infarction, 1.39 (1.10 to 1.76, p=.006) for heart failure, and 1.19 (0.94 to 1.51, p=.15) for all-cause mortality. In addition, inclusion of CAC score led to significant increase in c-statistic 0.02 (95% CI 0.00 to 0.09, p<.001) for predicting CVD over all above-mentioned established and novel CVD risk factors. CAC is independently and significantly related to the risks of CVD, myocardial infarction, and heart failure in CKD patients. In addition, CAC improves risk prediction for CVD, myocardial infarction, and heart failure over established and novel CVD risk factors among CKD patients, although the change in c-statistics is small.
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影响因子：
2
作者：
Pencina, Michael J.;D'Agostino, Ralph B., Sr.;Steyerberg, Ewout W.
通讯作者：
Steyerberg, Ewout W.
影响因子：
120.7
作者：
Polonsky, Tamar S.;McClelland, Robyn L.;Jorgensen, Neal W.;Bild, Diane E.;Burke, Gregory L.;Guerci, Alan D.;Greenland, Philip
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作者：
Matsushita, Kunihiro;van der Velde, Marije;Astor, Brad C.;Woodward, Mark;Levey, Andrew S.;de Jong, Paul E.;Coresh, Josef;Gansevoort, Ron T.
通讯作者：
Gansevoort, Ron T.
影响因子：
13.2
作者：
Russo, D;Palmiero, G;Andreucci, VE
通讯作者：
Andreucci, VE
影响因子：
2
作者：
Pencina, MJ;D'Agostino, RB
通讯作者：
D'Agostino, RB