Prediction of 10-year atherosclerotic cardiovascular disease risk among community residents in Shanghai,China – a comparative analysis of risk algorithms

Background and aimsThe accuracy of various 10-year atherosclerotic cardiovascular disease (ASCVD) risk models has been debatable. We compared two risk algorithms and explored clustering patterns across different risk stratifications among community residents in Shanghai.Methods and resultsA total of 28,201 residents (aged 40–74 years old) who were free of ASCVD were selected from the Shanghai Survey in China. The 10-year ASCVD risk was estimated by applying the 2013 Pooled Cohort Equations (PCEs) and Prediction for ASCVD Risk in China (China-PAR). The agreement was assessed between PCEs and China-PAR using Cohen's kappa statistics.The mean absolute 10-year ASCVD risk calculated by PCEs and China-PAR was about 10.0% and 6.0%, respectively. PCEs estimated that 44.9% of participants [with a 95% confidence interval (CI):44.0%–45.8%] were at high risk, while China-PAR estimated only 16.7% (95%CI:15.8%–18.0%) were at high risk. In both models, the percentage of high ASCVD risk was higher for participants who were older, men, less educated, current smokers, drinkers and manual workers. Among high-risk individuals, almost all participants (PCEs:90.5%; China-PAR:98.6%) had at least one risk factor; hypertension being the most prevalent. The concordance between PCEs and China-PAR was moderate (kappa:0.428, 95%CI: 0.420–0.434) with a better agreement for women (kappa:0.503,95%CI: 0.493–0.513) than for men (kappa:0.211,95%CI: 0.201–0.221).ConclusionThe proportion of participants with a 10-year ASCVD high risk predicted by China-PAR was lower than the results of the PCEs. The risk stratifications of the two algorithms were inconsistent in terms of demographic and life-behaviour characteristics.     

不同公式计算的估算肾小球滤过率对老年慢性肾脏病预后的分析

目的对比不同慢性肾脏病流行病合作研究(CKD-EPI)公式计算的估算肾小球滤过率(eGFR)在评估老年慢性肾脏病(CKD)患者预后中的诊断价值,并分析影响终点事件的危险因素。方法选取2015年3月至2018年12月于北京友谊医院医疗保健中心行健康体检的具有4年连续资料的老年人共682例。采用基于肌酐(Cr)的CKD-EPI(CKD-EPI_(Cr))公式、基于胱抑素C(Cys)的CKD-EPI(CKD-EPI_(Cys))公式及基于Cr和Cys联合的CKD-EPI(CKD-EPI_(CrCys))公式分别计算eGFR,评估各公式计算的eGFR对终点事件(全因死亡、心血管事件、急性肾损伤、快速肾功能下降)的诊断价值,分析影响预后的危险因素。采用SPSS 23.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ~2检验。受试者工作特征(ROC)曲线评估诊断价值,logistic回归分析影响预后的危险因素。结果 CKD-EPI_(Cys)(AUC=0.692,P0.001)及CKD-EPI_(CrCys)(AUC=0.647,P0.001)公式计算的eGFR对终点事件有诊断价值,其中CKD-EPI_(Cys)公式的诊断价值较高。CKD-EPI_(Cys)与CKD-EPI_(CrCys)公式计算eGFR评估的终点事件的危险因素相同,均为尿白蛋白/肌酐比值(UACR)(OR=2.263,95%CI 1.359～3.771)、高血压(OR=1.679,95%CI 1.143～2.467)、贫血(OR=1.959,95%CI 1.245～3.084)及住院次数(OR=1.471,95%CI 1.321～1.637)。结论 CKD-EPI_(Cys)公式计算的eGFR对老年CKD预后评估的诊断价值最有优势。UACR、贫血、高血压和住院次数是老年CKD患者发生终点事件的独立危险因素。     

健康人群衰老相关心血管亚临床指标与肾功能的相关性

目的 评价沈阳地区健康人群衰老相关心血管亚临床状态改变及其与肾小球滤过率(GFR)的相关性.方法 在横断面研究中,将沈阳地区505例健康人群按照年龄分为≤60岁组(n＝274)和>60岁组(n＝231).进行基本身体状况、血压、血液生化和心血管超声检查.采用左室射血分数(LVEF)评价心脏收缩功能,二尖瓣E峰与A峰的比值(E/A)、二尖瓣减速时间(MV-DT)、左房容积指数(LAVI)评价心脏舒张功能,颈动脉内中膜厚度(IMT)、臂踝指数(ABI)和脉搏波速度(PWV)评价血管结构和僵硬度.采用Cockcroft-Gault公式(GFRCG)、中国改良MDRD公式(GFRMDRD)和CKD-EPI(GFRCKD-EPI)公式计算的GFR评价肾脏功能.结果 在≤60岁组,GFRCG与IMT(r＝-0.238,P<0.01)和PWV(r＝-0.281,P<0.01)呈显著负相关.GFRMDRD与LVEF呈显著负相关(r＝-0.221,P<0.01).GFRCKD-EPI与IMT(r＝-0.360,P<0.01)和PWV(r＝-0.327,P<0.01)呈显著负相关.利用偏相关分析调整年龄、体质量指数、腰臀比、收缩压、舒张压、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇等混杂变量后,GFRCG与LAVI呈显著正相关(r＝0.168,P<0.05).GFRMDRD与LVEF呈显著负相关(r＝-0.212,P<0.01).GFRCKD-EPI与LAVI呈显著正相关(r＝0.195,P<0.01),与EA呈显著负相关(r＝-0.137,P<0.05).在>60岁组,GFRMDRD与ABI呈显著正相关(r＝-0.167,P<0.05),且在调整混杂变量后,该相关依然显著(r＝0.175,P<0.05).结论 衰老与肾功能下降、大动脉僵硬度及心脏舒张功能下降密切相关.在健康人群,心血管系统和肾脏存在年龄特异的交互作用.     

冠状动脉病变程度与估算肾小球滤过率的相关性

【摘要】 目的 研究冠状动脉病变程度与估算肾小球滤过率的相关性。方法 将在煤炭总医院心内科行冠状动脉造影的425例患者根据冠状动脉造影结果分为非冠心病组、冠状动脉单支病变组、冠状动脉双支病变组和冠状动脉三支病变组,收集患者的临床资料和相关生化检查指标,采用改良MDRD公式计算估算肾小球滤过率(eGFR),探讨冠状动脉病变程度与估算肾小球滤过率的相关性。结果 冠状动脉三支病变组血肌酐明显高于冠状动脉单支病变组,差异有统计学意义(123.72±165.88 vs 73.26±21.18, P<0.05);冠状动脉三支病变组eGFR低于冠状动脉单支病变组和冠状动脉双支病变组,差异有统计学意义(85.23±34.73 vs 98.33±34.62, 85.23±34.73 vs 96.30±32.84, P<0.05)。logistic回归分析显示：与冠脉双支病变相比eGFR与冠脉三支病变呈负相关(OR=0.987,95％CI 0.977-0.997,P= 0.014);与冠脉单支病变相比,血肌酐与冠脉三支病变呈正相关(OR=1.022,95％CI 1.003-1.040,P= 0.021)。结论 与冠脉双支病变相比,eGFR降低为冠脉三支病变的独立危险因素。肾功能不全与冠状动脉病变严重程度密切相关。     

Renal hyperfiltration defined by high estimated glomerular filtration rate: A risk factor for cardiovascular disease and mortality

Renal hyperfiltration, defined as an increased glomerular filtration rate above normal values, is associated with early phases of kidney disease in the setting of various conditions such as obesity and diabetes. Although it is recognized that glomerular hyperfiltration, that is, increased filtration per nephron unit (usually studied at low glomerular filtration levels and often referred to as single nephron hyperfiltration), is a risk factor for the progression of chronic kidney disease, the implications of having renal hyperfiltration for cardiovascular disease and mortality risk are incompletely understood. Recent evidence from diverse populations, including healthy individuals and patients with diabetes or established cardiovascular disease, suggests that renal hyperfiltration is associated with a higher risk of cardiovascular disease and all-cause mortality. In this review, we critically summarize the existing studies, discuss possible mechanisms, and describe the remaining gaps in our knowledge regarding the association of renal hyperfiltration with cardiovascular disease and mortality risk.     

汇集队列风险方程与China-PAR模型在体检人群ASCVD风险预测中的应用

目的比较汇集队列风险方程(PCE)和China-PAR模型在体检人群ASCVD风险预测中的应用。方法选择2018年1月至2018年6月期间于宜宾市第一人民医院和宜宾市第二人民医行健康体检的40岁以上成年人848例,采用PCE和China-PAR评估ASCVD发病风险,探讨PCE和China-PAR在ASCVD发生风险预测中的关联性和一致性。结果PCE和China-PAR预测的10年ASCVD发病风险概率分别为(5.4±2.4)%和(4.5±2.0)%,PCE预测结果高于China-PAR(P<0.05),按年龄段、性别和居住地分层比较,PCE预测结果也高于China-PAR;不管是PCE还是China-PAR,男性ASCVD发病风险高于女性,年龄越大风险概率越高(P<0.05)。PCE预测10年ASCVD发生风险为高危者192例(22.6%),China-PAR预测10年ASCVD发生风险为低危者507例(59.8%),中危326例(38.4%),高危15例(1.8%)。Pearson相关分析显示PCE和China-PAR预测的ASCVD发生风险概率有相关性,其Pearson相关系数为0.716(P<0.05)。PCE和China-PAR预测风险等级有一定关联性,列联系数r为0.200,kappa=0.152。结论PCE可能会高估中国人ASCVD发病风险,China-PAR可能更适合中国人,但需要大样本人群队列进行进一步验证。     

估计的肾小球滤过率与冠状动脉病变严重程度的相关性

目的分析估计的肾小球滤过率与冠状动脉病变严重程度的相关性。方法回顾性分析2005年3月至2010年9月在北京大学第三医院行冠脉造影并符合条件的2959例患者的临床及冠脉造影资料。根据冠脉病变情况分为无冠心病组（组1,649例）、单支病变组（组2,596例）、双支病变组（组3,591例）及多支病变组（组4;1123例）。根据简化的MDRD公式计算eGFR,根据eGFR值分为肾功能正常组（390例,eGFR≥90 m.lm in-1.1.73 m-2）、轻度减退组（1802例,60≤eGFR〈90 m.lm in-1.1.73 m-2）及中重度减退组（767例,eGFR〈60 m.lm in-1.1.73 m-2）。通过Spearm an相关及有序Logistic回归分析eGFR与冠脉病变严重程度的相关性。结果与肾功能正常组比较,肾功能轻度减退组、中重度减退组患者年龄大、女性患者比例及高血压的患病率高。肾功能中重度减退组患者糖尿病的患病率较肾功能正常组高。肾功能正常组、轻度减退组以及中重度减退组多支病变患者的比例分别为32.3%、35.2%和47.2%,差异有统计学意义（P〈0.001）。Spearm an相关分析显示冠脉病变严重程度与eGFR相关（r=-0.098,P〈0.001）。有序Logistic回归分析表明年龄、男性、高血压、糖尿病以及吸烟是冠脉病变严重程度的独立危险因素,而eGFR与冠脉病变严重程度之间的回归系数为-0.003,差异无统计学意义（P=0.109）。结论年龄、性别、高血压、糖尿病、吸烟是冠脉病变严重程度的独立危险因素。尽管冠脉病变严重程度与eGFR相关,但eGFR的降低不是冠脉病变严重程度的独立危险因素。     

High risks of all-cause and cardiovascular deaths in apparently healthy middle-aged people with preserved glomerular filtration rate and albuminuria: A prospective cohort study

Background

The reason why coexistence of preserved estimated glomerular filtration rate (eGFR) and albuminuria contributes to a high risk of death and which cause of death increases all-cause mortality have not been elucidated.

Methods

A total of 16,759 participants aged 40 to 69 years with normal or mildly reduced eGFR (45–119 ml/min/1.73 m²) were enrolled and divided into six groups (group 1, eGFR: 90–119 without albuminuria; group 2, eGFR: 90–119 with albuminuria; group 3, eGFR: 60–89 without albuminuria (reference); group 4, eGFR: 60–89 with albuminuria; group 5, eGFR: 45–59 without albuminuria; group 6, eGFR: 45–59 with albuminuria) based on GFR estimated by using the CKD-EPI study equation modified by a Japanese coefficient and albuminuria (urine albumin–creatinine ratio ≥ 30 mg/g). Outcomes included all-cause death (ACD), cardiovascular death (CVD) and neoplasm-related death (NPD). Multivariable-adjusted mortality rate ratios (RR) and their 95% confidence intervals (CIs) in the groups were estimated by Poisson's regression analysis.

Results

The highest risk of ACD (RR (95% CIs): 3.95 (2.08–7.52)), CVD (7.15 (2.25–22.7)) and NPB (3.25 (1.26–8.38)) was observed in group 2. Subjects in group 2 were relatively young and had the highest levels of body mass index, blood pressure and HbA_1c and the highest prevalence of diabetes and metabolic syndrome.

Conclusion

Coexistence of preserved eGFR and albuminuria increases risks for ACD, CVD and NPD. Relatively young metabolic persons having both preserved eGFR and albuminuria should be considered as a very high-risk population.     

Association between metabolic syndrome and estimated glomerular filtration rate in older Koreans based on data from the third Korean National Health and Nutrition Examination Survey

Aim: To examine the association between metabolic syndrome (MetS) and renal function in older Koreans. Methods: A total of 1270 people aged 60 years and older who participated in the third Korean National Health and Nutrition Examination Survey were included in this study. Results: After adjusting for confounding factors, central obesity, high‐density lipoprotein cholesterol and fasting glucose were significantly associated with decreased renal function in men. In women, however, each component of MetS with the exception of fasting glucose was not associated with renal function. The odds ratios for MetS were 2.548 in men and 1.454 in women after adjustment for confounding variables; both were statistically significant. The odds ratio of decreased renal function increased as the number of components of MetS increased. Conclusion: The results of this study suggest that MetS may be an independent risk factor for decreased renal function in older population as well.     

Inpatients with coronary heart disease have a high prevalence of chronic kidney disease based on estimated glomerular filtration rate (eGFR) in China

The objective of this study was to calculate estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr) and to estimate the prevalence of chronic kidney disease (CKD) in patients with coronary heart disease (CHD) in China. This was a cross-sectional study using data from China Heart Survey (CHS). Glomercular filtration rate was estimated with the Modified Diet in Renal Disease (MDRD) equation. The prevalence of CKD among the 3 513 CHS participants with coronary heart disease was 24.8% (n = 871). Compared with study participants without CKD, study participants with CKD were more likely to have hypertension (49.5% vs 42.8%; P = 0.001), diabetes (43.1% vs 29.5; P < 0.001) and elevated systolic blood pressure. The mean (SD) high-density lipoprotein cholesterol (HDL-C) of the participants with CKD was lower than those without CKD (P = 0.003). Prevalence of CKD among the participants of CHS between different admissions of CHD showed a significant difference (χ² = 32.012, P < 0.001). On average, participants with a lower estimated GFR were older, less likely to be current smokers, and more likely to have hypertension and low HDL-C. The results of our study suggested a high prevalence of CKD (24.8%) in Chinese adults with coronary heart disease. Our study provided further evidence that patients with CKD should be considered at high risk for CHD outcomes and identifies patients with CKD as potential candidates for aggressive risk factor reduction.     

Wall motion index, estimated glomerular filtration rate and mortality risk in patients with heart failure or myocardial infarction: a pooled analysis of 18,010 patients

AIMS: This study was designed to assess whether the prognostic significance of estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) interact in populations with heart failure (HF) and myocardial infarction (MI). METHODS: Patients were recruited from four screening registers (N=18,010) including patients admitted with HF or MI. Ten years follow-up was recorded and formal testing for interactions between eGFR and LVEF with respect to outcome was done. RESULTS: Twelve-thousand-and-ninety patients died. A significant interaction (P=0.010) was found and each parameter became relatively more important when the value of the other was low. eGFR and LVEF were reparameterized to categorical variables and we observed that chronic kidney disease stage II was associated with a decreased (Hazard ratio (HR): 0.79 (95% Confidence Interval: 0.72-0.86)) and chronic kidney disease stages IV (HR: 1.60 (1.45-1.91) and V (HR: 1.91 (1.45-2.52) were associated with an increased mortality risk with an additive effect of left ventricular systolic dysfunction (LVSD). CONCLUSION: The prognostic significance of eGFR and LVEF is synergistic in patients with HF or MI and the impact of one parameter is inversely related to the level of the other. Statistical interactions are scale dependent and the relationship between chronic kidney disease stages I to V and mortality risk is J-shaped with an additive effect of LVSD.     

All-cause and cardiovascular mortality in diabetic subjects increases significantly with reduced estimated glomerular filtration rate (eGFR): 10 years' data from the South Tees Diabetes Mortality study.

AIMS: To investigate the association between estimated glomerular filtration rate (eGFR) and total and cardiovascular mortality in a population-based cohort of diabetic subjects. METHODS: A longitudinal study using a population-based district diabetes register comprising 3288 subjects in South Tees, UK. The eGFR was calculated using the Modification of Diet in Renal Disease (MDRD) study equation. Patients were stratified by baseline eGFR into five stages as per the National Kidney Foundation guidelines: Stage 1, eGFR > 90; Stage 2, eGFR 60-89; Stage 3, eGFR 30-59; Stage 4, eGFR 15-29; and Stage 5, eGFR < 15 ml/min per 1.73 m(2). Main outcome was all-cause and cardiovascular mortality between 1 January 1994 and 31 July 2004. RESULTS: At baseline, mean age (58.4 years) differed between groups. Persons with lower eGFR were older (P < 0.001). Thirty-six percent (n = 1193, males 56%) had died by 10 years (cardiovascular cause in 60%). Median follow-up was 10.5 years amounting to 28 342 person years. Stages 4 and 5 (eGFR 相似文献   

Difference between CKD-EPI and MDRD equations in calculating glomerular filtration rate in patients with cirrhosis

AIM:To evaluate the difference between the performance of the (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) equations in cirrhotic patients. METHODS: From Jan 2004 to Oct 2008, 4127 cirrhotic patients were reviewed. Patients with incomplete data with respect to renal function were excluded; thus, a total of 3791 patients were included in the study. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD (MDRD-4), 6-variable MDRD (MDRD-6), and CKD-EPI equations.RESULTS:When ser...     

老年高血压患者血压昼夜波动与肾小球滤过率下降的关系

目的探讨老年高血压患者血压昼夜波动与肾小球滤过率(glomerular filtration rate,GFR)下降的关系。方法对178例老年高血压患者测定血清肌酐,以Cockroff-Gault公式计算GFR估测值(eGFR),根据eGFR≥90ml/(min·1.72 m~2)、60～89 ml/(min·1.72 m~2)、40～59 ml/(min·1.72 m~2)、<40 ml/(min·1.72 m~2)分为A组44例、B组59例、C组46例、D组29例,并行24 h动态血压监测,测定空腹血糖、TC、TG、LDL-C、HDL-C,计算体重指数。结果 A组、B组、C组和D组随着eGFR的下降,夜间收缩压、24 h脉压、昼间脉压、夜间脉压、收缩压晨峰逐渐升高;舒张压波动幅度、夜间收缩压下降率、夜间脉压下降率逐渐降低,差异有统计学意义(P<0.05)。Pearson相关分析显示,病程、夜间收缩压、收缩压晨峰、24 h脉压、夜间脉压及夜间舒张压下降率与eGFR呈负相关,夜间舒张压、舒张压波动幅度、夜间收缩压下降率、夜间脉压下降率与eGFR呈正相关(P<0.05,P<0.01)。结论血压昼夜节律和波动幅度的异常与eGFR下降密切相关,尤以夜间脉压增大为著。     

The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years.

AIMS: Moderate-to-severe chronic renal failure is an established risk factor for cardiovascular disease and mortality. However, most studies have been performed in selected populations and the impact of very small decrements of renal function on long-term cardiac morbidity and mortality has not yet been established. Also, the cut-off level of glomerular filtration rate (GFR) from which cardiovascular risk increases has not exactly been established. This study wants to address these questions. METHODS AND RESULTS: Ten year follow-up of a representative population-based cohort comprised 8913 randomly selected, apparently healthy participants. Participants were randomly drawn from Belgian voting lists. Cardiovascular risk factors were noted. Serum creatinine values were corrected to isotope dilution mass spectrometry standard, and GFR was calculated using the recently modified 'modification of diet in renal disease' equation. Participants were followed for 10 years, and cause-specific death was registered by analysis of death certificates. The probability to die from all causes or from cardiovascular causes during the 10 year follow-up period increased in each quartile of GFR, even after correction for different other comorbid conditions. CONCLUSION: Even mild renal failure is an independent risk factor for cardiovascular mortality within 10 years in an apparently healthy unselected population. This detrimental effect starts already at a relatively high GFR of 90 mL/min/1.73 m2 and remains present after correction for other established cardiovascular risk factors.     

The association between estimated glomerular filtration rate,albuminuria, and risk of cardiovascular hospitalizations and all-cause mortality among patients with type 2 diabetes

Aims

We evaluated the simultaneous effects of all clinically recognized categories of albuminuria and estimated glomerular filtration rate (eGFR) on cardiovascular disease (CVD) and mortality