Uric acid, microalbuminuria and cardiovascular events in high-risk patients.
Uric acid, microalbuminuria and cardiovascular events in high-risk patients.
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DOI：
10.1159/000084073
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发表时间：
2005-01-01
影响因子：
4.2
通讯作者：
Tuttle, Katherine R
中科院分区：
文献类型：
--
作者：
Short, Robert A;Johnson, Richard J;Tuttle, Katherine R
背景：血清尿酸和蛋白尿水平升高与心血管疾病有关，但这种关系并不总是被证明独立于高血压、其他危险因素或相互独立。这项研究的目的是评估心血管疾病的高危人群尿酸和微量蛋白尿对心血管事件的影响。方法：连续接受选择性冠状动脉造影术的患者(n=316)在基线时评估冠状动脉疾病、危险因素、肾功能和利尿剂的使用。结果：心血管事件发生率为10%。心血管事件与基线指标显著相关(p<；0.05)，包括尿酸和尿酸；或=5.2 mg/dl，总胆固醇和总胆固醇；或=200 mg/dl，严重冠状动脉造影术，利尿剂循环治疗，以及高血压的诊断。逐步COX建模程序确定尿酸(p=0.040)、高血压和尿酸的相互作用(p=0.029)、总胆固醇和严重冠状动脉疾病的相互作用(p=0.001)和利尿剂循环治疗(p=0.009)是显著的独立预测因素。虽然微量白蛋白尿没有保留在最终的多变量模型中，但它与较差的心血管疾病结局有关。白蛋白/肌酐比值为30 mg/g的患者平均无事件生存期为51个月，白蛋白/肌酐比值为5.2 mg/dl的患者在5年期间心血管死亡和主要临床事件的风险增加3.5倍(OR 3.5，95%可信区间1.0-11.9)。尿酸可能是动脉粥样硬化及其并发症进展的一个促成因素。
BACKGROUND: Elevated levels of serum uric acid and albuminuria are associated with cardiovascular disease, but the relationships have not consistently been demonstrated to be independent of hypertension, other risk factors, or each other. The purpose of this study was to evaluate people at high risk for cardiovascular disease for the influence of uric acid and microalbuminuria on cardiovascular events.METHODS: Consecutive consenting patients undergoing elective angiography (n = 316) had coronary artery disease, risk factors, renal function and diuretic use assessed at baseline. Cardiovascular mortality and major clinical events (myocardial infarction, stroke, amputation, and kidney failure) were ascertained over 5 years.RESULTS: Cardiovascular events occurred in 10% of the patients. Significant correlates (p < 0.05) of cardiovascular events with baseline measures included uric acid > or =5.2 mg/dl, total cholesterol > or =200 mg/dl, severe angiographic coronary artery disease, loop diuretic therapy, and diagnosis of hypertension. A stepwise Cox modeling procedure identified uric acid (p = 0.040), the interaction of hypertension and uric acid (p = 0.029), the interaction of total cholesterol and severe coronary artery disease (p = 0.001) and loop diuretic therapy (p = 0.009) as significant independent predictors of events. Although microalbuminuria was not retained in the final multivariate model, it was associated with poorer cardiovascular disease outcomes. The mean event-free survival for albumin-to-creatinine >30 mg/g was 51 months and for albumin-to-creatinine or =5.2 mg/dl independently imparted a 3.5-fold increased risk (OR 3.5, 95% CI 1.0-11.9) for cardiovascular death and major clinical events over a 5-year period. Uric acid may be a contributing factor to the progression of atherosclerosis and its complications.