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）：即使在调整了年龄、糖尿病、性别和种族后，终末期肾病患者的心血管疾病 (CVD) 发病率仍是普通人群的 10-20 倍。 美国国家肾脏基金会心血管疾病工作组得出的结论是，应重点关注与尿毒症相关的危险因素，如蛋白尿、Lp(a) 升高和同型半胱氨酸，这些因素的不良情况会随着慢性肾脏病 (CKD) 的进展而恶化。 由于一半的心血管事件发生在没有任何已知传统危险因素的患者身上，因此筛查亚临床 CVD 以识别高危个体非常重要。 对 CKD 患者是否存在心血管疾病，特别是冠状动脉疾病的最佳评估尚不清楚。 通过超声测量颈动脉内膜中层厚度（IMT）已被证明可以评估动脉粥样硬化的程度和严重程度。 拟议的研究将前瞻性地检查 100 名无症状 CKD 且无糖尿病的患者，并确定非传统危险因素（如同型半胱氨酸、脂蛋白 (a) 和 C 反应蛋白）是否是亚临床心血管疾病存在和进展的独立危险因素（通过重复无创测量来测量）颈动脉超声 IMT 测量在 24 个月的时间间隔内根据已知的心血管危险因素进行调整。 我们建议利用这种有前途的新型非侵入性技术对亚临床 CVD 进行定量评估。 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的目标。 为了确定基线颈动脉 IMT，分析工具将是多元线性回归。 变化将通过 IMT 测量值的差异来衡量。 使用标准混合效应生长曲线的模型将用于允许估计个体受试者的斜率和截距，以及比较由基线或随时间变化的协变量定义的组。 阐明这些关系是确定心血管疾病进展的可改变危险因素的重要组成部分，并可能导致对易于识别的高危人群采取有针对性的医疗干预措施，以减少疾病进展。