Cardiac Risk Factors in Chronic Kidney Disease

慢性肾脏病的心脏危险因素

• 批准号: 6928144
• 负责人: MARK J SARNAK
• 金额: $ 20.38万
• 依托单位: TUFTS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6928144
• 关键词: cardiovascular disorder epidemiology; cardiovascular disorder risk; cerebrovascular disorders; chronic renal failure; coronary disorder; human data; mathematical model; medical complication; model design /development; myocardial infarction; prognosis; statistics /biometry

DESCRIPTION (provided by applicant): Chronic kidney disease (CKD) is a major public health problem with as many as 20 million affected individuals in the US. Cardiovascular disease (CVD) is the primary cause of morbidity and mortality in CKD, and the presence of CKD is now recognized as an independent risk factor for development of CVD. The mechanism through which CKD increases CVD risk is however not well understood. Patients with CKD may be at increased risk for CVD because they may have an increased prevalence and severity of traditional risk factors, as defined by the Framingham population. Patients with CKD, are however, also exposed to a vast array of novel CVD factors, that increase in prevalence as kidney function declines (non traditional risk factors). There are few studies, however, that have evaluated the relative importance of traditional and non-traditional risk factors in patients with CKD. The Framingham coronary risk score uses a composite of traditional CVD risk factors to estimate the risk for incident coronary heart disease (CHD) in the general population. The risk score, has not however, been evaluated in prospective studies of patients with CKD. We propose to pool subjects with CKD, defined by an estimated glomerular filtration rate of 15 to 60 ml/min/1.73 m2, in two well-characterized cohorts: the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. This pooled CKD cohort is representative of the US population with CKD. Our general hypothesis is that the Framingham coronary risk score will not accurately predict CHD events in patients with CKD. Our specific aims are as follows. 1. To evaluate risk factors for CHD, cerebrovascular disease and all-cause mortality in 1678 subjects with CKD. 2. To compare the relative risk ascribed to each traditional risk factor in patients with CKD with that in the Framingham population, and to evaluate the discriminatory capacity and the calibration potential of the. Framingham coronary risk score to predict incident myocardial infarction (MI)/fatal CHD in 1105 subjects with CKD but without CVD. 3. To develop and evaluate a new prediction equation for Ml/fatal CHD in CKD utilizing both traditional and non-traditional factors. Achievement of the aims outlined is realistic. Statistical analyses reveal adequate power to evaluate each of the aims. Evaluating the importance of traditional and non-traditional risk factors in CKD is essential in that it will focus attention on the most important cardiac risk factors in this population.

描述（由申请人提供）：慢性肾病 (CKD) 是一个主要的公共卫生问题，美国有多达 2000 万人受影响。心血管疾病（CVD）是 CKD 发病和死亡的主要原因，CKD 的存在现已被认为是 CVD 发生的独立危险因素。然而，CKD 增加 CVD 风险的机制尚不清楚。 CKD 患者患 CVD 的风险可能会增加，因为按照弗雷明汉人群的定义，他们的传统危险因素的患病率和严重程度可能会增加。然而，慢性肾病患者也面临着大量新型心血管疾病因素，这些因素的患病率随着肾功能下降而增加（非传统危险因素）。然而，很少有研究评估传统和非传统危险因素对 CKD 患者的相对重要性。弗雷明汉冠状动脉风险评分使用传统 CVD 风险因素的综合来评估一般人群中发生冠心病 (CHD) 的风险。然而，尚未在 CKD 患者的前瞻性研究中评估风险评分。我们建议将 CKD 受试者（根据估计肾小球滤过率 15 至 60 ml/min/1.73 m2 定义）合并到两个特征明确的队列中：社区动脉粥样硬化风险研究和心血管健康研究。这个合并的 CKD 队列代表了美国 CKD 人群。我们的一般假设是弗雷明汉冠状动脉风险评分不能准确预测 CKD 患者的 CHD 事件。我们的具体目标如下。 1. 评估 1678 名 CKD 受试者的 CHD、脑血管疾病和全因死亡率的危险因素。 2. 比较 CKD 患者与 Framingham 人群中每个传统危险因素的相对风险，并评估其区分能力和校准潜力。 Framingham 冠状动脉风险评分可预测 1105 名患有 CKD 但无 CVD 的受试者发生心肌梗塞 (MI)/致命性 CHD。 3. 利用传统和非传统因素开发和评估 CKD 中的 MI/致命性 CHD 的新预测方程。实现所概述的目标是现实的。统计分析揭示了评估每个目标的足够能力。评估 CKD 中传统和非传统危险因素的重要性至关重要，因为它将重点关注该人群中最重要的心脏危险因素。