Novel Cardiovascular Risk Factors in Renal Insufficiency

肾功能不全的新心血管危险因素

• 批准号: 6728721
• 负责人: Sylvia E Rosas
• 金额: $ 15.85万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-15 至 2006-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6728721
• 关键词: acute phase protein; atherosclerosis; biomarker; blood lipoprotein; cardiovascular disorder risk; carotid artery; chronic renal failure; clinical research; coronary disorder; disease /therapy duration; homocysteine; human subject; longitudinal human study; mass screening; morphometry; pathologic process; patient oriented research; questionnaires; ultrasound

DESCRIPTION (provided by applicant): The incidence of cardiovascular disease (CVD) is 10-20 fold greater in end-stage renal patients compared to the general population even after adjusting for age, diabetes, gender and race. The National Kidney Foundation Task Force on Cardiovascular Disease concluded that emphasis should be placed on risk factors related to uremia such as proteinuria, elevated Lp(a) and homocysteine whose adverse profile worsens as the chronic kidney disease (CKD) progresses. Because half of all cardiovascular events occur in patients without any known traditional risk factors, it is important to screen for subclinical CVD in an effort to identify high-risk individuals. The optimal evaluation for the presence of cardiovascular disease in particular coronary artery disease in patients with CKD is unknown. Carotid intima-media thickness (IMT) measured by ultrasound has been shown to assess the extent and severity of atherosclerosis. The proposed study will examine prospectively 100 asymptomatic patients with CKD and without diabetes and determine if nontraditional risk factors such as homocysteine, lipoprotein (a) and C-reactive protein are independent risk factor for presence and progression of subclinical cardiovascular disease as measured by repeated noninvasive carotid US measures of IMT adjusting for known cardiovascular risk factors over a 24-month interval. We propose to utilize this promising new non-invasive technique for the quantitative assessment of subclinical CVD. We are responding to program announcement PA-01-127 which includes the objective of use of epidemiological and biochemical approaches to identifying new, non-traditional risk factors for cardiovascular disease in patients with CKD. For the determination of baseline carotid IMT, the tool of analysis will be multiple linear regression. A change will be measured by the difference in IMT measurements. Models using standard mixed effects growth curves will be used to allow both the estimation of individual subjects' slopes and intercepts and for the comparison of groups defined by baseline or time varying covariates. Elucidation of these relationships is an essential component of identifying modifiable risk factors for the progression of cardiovascular disease and may lead to targeted medical interventions to easily identifiable high-risk groups to decrease disease progression.

描述（由申请人提供）：即使在调整年龄，糖尿病，性别和种族后，末期肾脏患者的心血管疾病（CVD）的发生率也比一般人群高10-20倍。 国家肾脏基金会对心血管疾病的工作组得出的结论是，应重点放在与尿emia有关的危险因素上，例如蛋白尿，LP升高（A）和同型半胱氨酸，其不良特征随着慢性肾脏病（CKD）的进展。 由于所有心血管事件的一半发生在没有任何已知传统危险因素的患者中，因此筛选亚临床CVD以识别高危人士很重要。 对于CKD患者，对心血管疾病特别是冠状动脉疾病的最佳评估尚不清楚。 通过超声测量的颈动脉内膜厚度（IMT）已被证明可以评估动脉粥样硬化的程度和严重程度。 拟议的研究将检查前瞻性的100例CKD且无糖尿病的患者，并确定非传统的风险因素（例如同型半胱氨酸，脂蛋白（A）和C反应蛋白是独立的危险因素，是在不存在的非侵入性carotif carotif conting carotifiars测量中的24次衡量的独立风险因素，并且是对IM的反复衡量的24个危险因素，而不是IM的高度危险因素。 间隔。 我们建议利用这种有希望的新的非侵入性技术进行亚临床CVD的定量评估。 我们正在响应计划公告PA-01-127，其中包括使用流行病学和生化方法来识别CKD患者心血管疾病的新的非传统危险因素。 为了确定基线颈动脉IMT，分析工具将是多个线性回归。 更改将通过IMT测量的差异来衡量。 使用标准混合效应生长曲线的模型将用于允许对单个受试者的斜率和截距的估计以及根据基线或时间变化的协变量定义的组进行比较。 阐明这些关系是确定心血管疾病进展的可修改风险因素的重要组成部分，并可能导致有针对性的医疗干预措施易于识别可识别的高风险群体以降低疾病进展。