Cardiac Risk Factors in Chronic Kidney Disease

描述（由申请人提供）：慢性肾脏疾病（CKD）是一个主要的公共卫生问题，在美国有多达2000万患者。心血管疾病（CVD）是CKD发病和死亡的主要原因，CKD的存在现在被认为是CVD发展的独立危险因素。然而，CKD增加CVD风险的机制尚不清楚。根据Framingham人群的定义，CKD患者患CVD的风险可能会增加，因为他们可能具有更高的患病率和传统危险因素的严重程度。然而，CKD患者也暴露于大量新的CVD因素中，这些因素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CKD患者中传统和非传统危险因素的相对重要性。Framingham冠状动脉危险评分使用传统心血管疾病危险因素的组合来估计普通人群发生冠心病（CHD）的风险。然而，风险评分尚未在CKD患者的前瞻性研究中进行评估。我们建议将CKD患者（肾小球滤过率估计为15 - 60ml /min/1.73 m2）纳入两个特征明确的队列：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队列是美国CKD患者的代表。我们的一般假设是，Framingham冠状动脉风险评分不能准确预测CKD患者的冠心病事件。我们的具体目标如下。1. 评价1678例CKD患者冠心病、脑血管疾病及全因死亡率的危险因素。2. 比较CKD患者与Framingham人群中各传统危险因素的相对危险度，并评价该方法的鉴别能力和校准潜力。Framingham冠状动脉危险评分预测1105例CKD但无CVD受试者的心肌梗死(MI)/致死性冠心病3. 利用传统和非传统因素，建立并评价CKD中Ml/致命性冠心病的新预测方程。上述目标的实现是现实的。统计分析显示了足够的能力来评估每一个目标。评估CKD中传统和非传统危险因素的重要性至关重要，因为它将把注意力集中在这一人群中最重要的心脏危险因素上。

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.