LI Jian;LI Yong;HUANG Cheng-lei;LUO Xin-ping;SHI Hai-ming;ZHU Rong-ying;XU Xu-ling
. 2009, 36(1): 46-52.
Objective To assess the relationship between estimated glomerular filtration rate (eGFR) and traditional coronary risk factors. Methods Six hundreds and fifty-seven consecutive patients who had undergone coronary angiography were divided into 3 groups according to baseline renal functional status eGFR: groupⅠconsisted of 301 patients with normal renal function eGFR＞90 mI·min-1·1.73 m-2; group Ⅱ included 303 patients with mild renal impairment (eGFR 60 - 89); and group Ⅲ comprised 53 patients with moderate and severe renal dysfunction eGFR＜60 mI·min-1·1.73 m-2. Clinical features and coronary risk factors were compared among the 3 groups. Results Patients with moderate and severe renal dysfunction were older than those with mild renal impairment. (median age 75 yrs old vs median age 69 yrs old, P＜0.001), while patients with moderate and severe renal dysfunction were older than those with normal renal function (median age 69 yrs old vs median age 61 yrs old, P＜0.001). The incidence of coronary artery disease (77.4% vs 56.8%, P=0.004) were significantly higher in group Ⅲ. The level of systolic blood pressure (SBP) was negatively correlated with the level of eGFR (r=-0.082, P=0.036) Setting the median value of SBP as well as eGFR as cut points, all patients were divided into SBP<125 mmHg and eGFR≥88 mI·min-1·1.73 m-2 group. The patients with SBP≥125 mmHg and eGFR＜88 mI·min-1·1.73 m-2 had a significantly increased percentage of coronary artery disease (CAD) compared with those with SBP≥125 mmHg and eGFR≥88 mI·min-1·1.73 m-2 (70.2% vs 57.2%, P=0.011). The level of HDL-C was positively correlated with the level of eGFR (r=0.084, P=0.008) as well as after controlling for the effects of smoking, aging, BMI, hypertension, dyslipidemia, systolic blood pressure, diabetes and family history of premature CAD (r=0.095, P=0.016). Setting the median value of HDL-C as well as eGFR as cut points, all patients were divided into HDL-C≥1.1 mmol/L and eGFR≥88 mI·min-1·1.73 m-2 group, when HDL-C<1.1 mmol/L, the incidence of coronary artery disease was also higher in patients with moderate and severe renal dysfunction (74.0% vs 62.9%, P=0.037). Logistic regression model was used to assess the association of renal insufficiency with CAD in patients with hypertension, in which aging, diabetes, smoking, dyslipidemia, family history of premature CAD were listed as covariates. Moderate and severe renal insufficiency (OR=2.350, P=0.040) entered the model. Patients with eGFR less than 60 mI·min-1·1.73 m-2 (OR=2.176) had an increased risk of CAD compared with those with eGFR more than 60 mI·min-1·1.73 m-2. The risk degree of CAD caused by hypertension, smoking, diabetes and aging was 1.515, 1.566, 2.404 and 3.420 respectively. Conclusions Renal insufficiency was one of the CVD risk factors as well as aging, smoking, diabetes and hypertension, especially in patients with hypertension. It is suggested that patients with renal insufficiency should pay more attention to CAD prevention.
