Serum Total Homocysteine and C-Reactive Protein as Pred

描述 (申请者摘要)糖尿病肾病患者明显 动脉硬化性心血管病的发病率和死亡率增加 血管疾病[心血管疾病]已确定的动脉硬化危险因素，如年龄、 性行为、吸烟、高血压和皮质疏松症不在考虑之列 足以应对这种超额的心血管疾病风险。来自一般信息的预期数据 人群，以及来自两个糖尿病队列的更有限的发现。和 患有慢性肾脏疾病的队列，与总水平升高有关 角半胱氨酸(THcy)和C反应蛋白(CRP)与动脉硬化性心血管疾病的关系 发病率和死亡率。基线血清总同型半胱氨酸和C反应蛋白的测定 厄贝沙坦在2型糖尿病肾病试验(IDNT)中的浓度 Cohort提供了一个真正独特的机会来评估潜力 这些推定的心血管疾病危险因素与 在该患者群体中，随后的心血管疾病发病率和死亡率。特定的 目标I(纵向分析)：评估潜在的“独立” 血清总角蛋白半胱氨酸基线浓度之间的关系 (THcy)和C反应蛋白(CRP)在整个IDNT队列中，以及 随后：合并心血管疾病发病率和死亡率(初步分析)。总计 死亡率，(*对已确定的预测因子进行多变量调整后 心血管疾病发病率/死亡率和总死亡率)。特定目标2-(交叉- 横断面分析)：评估基线血清总环半胱氨酸(THcy)和 全IDNT血型中C反应蛋白(CRP)浓度的关系 这些分析物的潜在基线决定因素，包括：维生素B 状况；年龄和性别；肾功能指数，即以肌酐为基础的肾小球滤过率 估计，和蛋白尿；甘油指数，普遍存在的心血管疾病 疾病(CVD)、传统的CVD危险因素(即，尤其是吸烟、 血压和总胆固醇/高密度脂蛋白胆固醇比率)。vbl.使用 比例风险建模，拥有1650个完整的数据 受试者，在双尾字母为0.05的情况下，我们将有83.0%的功率来检测 心血管疾病发生总数的相对风险估计(危险比)为1.4， 将四分位数4与丙型肝炎病毒或C反应蛋白的四分位数1-3进行比较。我们的潜在客户 研究结果将有助于阐明对这些假定的心血管疾病风险的测量 这些因素可能为轻度到中度的心血管疾病风险评估提供有用的信息 尤其是糖尿病肾病引起的中度肾功能不全。

DESCRIPTION (Applicant's Abstract) Patients with diabetic nephropathy experience markedly increased rates of morbidity and mortality due to arteriosclerotic cardio- vascular disease [CVD]. Established arteriosclerotic risk factors such as age, sex, cigarette smoking, hypertension, and dysilpidernia do not account adequately for this excess CVD risk. Prospective data from general populations, and much more limited findings from both diabetic cohorts. and cohorts with chronic renal disease, have linked elevated levels of total hornocysteine (tHcy) and C-reactive protein (CRP) to arteriosclerotic CVD morbidity and mortality. Determination of baseline serum tHcy and CRP concentrations in the Irbesartan Type 2 Diabetic Nephropathy Trial (IDNT) cohort affords a truly unique opportunity to evaluate the potential independent relationship between these putative CVD risk factors and subsequent CVD morbidity and mortality, in this patient population. Specific Aim I (Longitudinal analyses): To evaluate the potential "Independent" relationship* between baseline concentrations of serum total hornocysteine (tHcy) and C-reactive protein (CRP) in the full IDNT cohort, and subsequent:pooled CVD morbidity and mortality (primary analysis). total mortality, (*after multivariable -adjustment for the established predictors of CVD morbidity/ mortality, and total mortality). Specific Aim 2 -(Cross- sectional analyses): To assess baseline serum total hornocysteine (tHcy) and C-reactive protein (CRP) concentrations in the full IDNT collort, in relation to potential baseline determinants of these analytes, including: B-vitamin status; age and gender; renal function indices, i.e. both creatinine-based GFR estimates, and proteinuria; indices of glycernia, prevalent cardiovascular disease (CVD), traditional CVD risk factors (i.e., in particular, smoking, blood pressure, and total cholesterol/HDL cholesterol ratio). Using proportional hazards modeling, with complete data available from 1650 total subjects, we will have 83.0% power at a two-tailed alpha of 0.05 to detect a relative risk estimate (hazards ratio) for total CVD Occurrence of 1.4, comparing quartile 4, to quartiles 1-3 of either tHcv or CRP. Our prospective findings will help elucidate whether measurement of these Putative CVD risk factors may provide useful Information for CVD risk assessment in mild to moderate renal insufficiency due to diabetic nephropathy, specifically.