Serum Total Homocysteine and C-Reactive Protein as Pred

描述 （申请人的摘要）患有糖尿病肾病的患者明显经历糖尿病性肾病。 心血管疾病的发病率和死亡率增加， 血管疾病[CVD]。已确定的动脉炎风险因素，如年龄， 性别、吸烟、高血压和肾上腺素缺乏症不起作用 足以应对这种过度的CVD风险。来自一般的前瞻性数据 人群，以及两个糖尿病队列的发现更加有限。和 慢性肾脏疾病队列，与总水平升高有关。 高同型半胱氨酸（tHcy）和C-反应蛋白（CRP）与动脉粥样硬化性心血管病 发病率和死亡率。 基线血清tHcy和CRP测定 厄贝沙坦2型糖尿病肾病试验（IDNT）中的浓度 队列提供了一个真正独特的机会来评估潜在的 这些推定的CVD风险因素之间的独立关系， 随后的CVD发病率和死亡率。具体 目的I（纵向分析）：评价潜在的“独立” 血清总角半胱氨酸基线浓度之间的关系 * （tHcy）和C-反应蛋白（CRP），以及 随后：合并CVD发病率和死亡率（主要分析）。总 死亡率，（* 多变量后-对已确定的预测因子进行调整， CVD发病率/死亡率和总死亡率）。具体目标2 -（交叉- 部分分析）：评估基线血清总高同型半胱氨酸（tHcy）和 C反应蛋白（CRP）浓度在整个IDNT collort中， 这些分析物的潜在基线决定因素，包括： 状态;年龄和性别;肾功能指数，即基于肌酐的GFR 估计，和蛋白尿;甘油血症指数，普遍心血管疾病 疾病（CVD），传统的CVD风险因素（即，特别是吸烟， 血压和总胆固醇/HDL胆固醇比率）。使用 比例风险建模，共有1650份完整数据 受试者，我们将有83.0%的把握度在双尾α为0.05时检测到 总CVD发生率的相对风险估计（危害比）为1.4， 比较tHcv或CRP的四分位数4与四分位数1-3。我们的潜在 研究结果将有助于阐明这些推定的CVD风险的测量是否 这些因素可能为轻度至重度的心血管疾病风险评估提供有用的信息。 糖尿病肾病导致的中度肾功能不全

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.