Kidney Dysfunction, Inflammation, and Coronary Events
| Autor: | JoAnn E. Manson, Eric B. Rimm, Eric L. Knight, Meir J. Stampfer, Kathryn M. Rexrode, Jennifer K. Pai, Carolyn C. Cannuscio, Gary C. Curhan |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Nephrology medicine.medical_specialty Pathology Renal function Coronary Disease Kidney Gastroenterology Receptors Tumor Necrosis Factor Body Mass Index chemistry.chemical_compound Chlorides Chromium Compounds Internal medicine Odds Ratio Humans Medicine Prospective Studies Myocardial infarction Prospective cohort study Inflammation Creatinine business.industry Case-control study General Medicine Odds ratio Middle Aged medicine.disease medicine.anatomical_structure chemistry Case-Control Studies Multivariate Analysis Female business Biomarkers |
| Zdroj: | Journal of the American Society of Nephrology. 15:1897-1903 |
| ISSN: | 1046-6673 |
| DOI: | 10.1097/01.asn.0000128966.55133.69 |
| Popis: | Kidney dysfunction and high C-reactive protein (CRP) levels are independently associated with coronary events. However, it is unclear whether the risk of coronary events associated with decreased kidney function is at least partially mediated by inflammation and whether the association between inflammatory biomarkers and coronary events is influenced by level of kidney function. With the use of a prospective, nested, case-control study design, the association among kidney function, inflammatory biomarker levels, and coronary events was studied. A total of 244 women who were participants in the Nurses' Health Study and had no history of cardiovascular disease received a diagnosis of an incident coronary event (defined as nonfatal myocardial infarction or death as a result of coronary disease) during the follow-up period from 1990 to 1998 and were matched to 486 control subjects. Serum creatinine and inflammatory biomarker levels were measured in blood samples collected in 1989. Creatinine clearance (CrCl) was estimated using creatinine, age, weight, and height. In multivariate analyses, the odds ratio (OR) for a coronary event in women with an estimated CrCl60 ml/min was 2.33 (95% confidence interval [CI], 1.01 to 5.38) compared with those with a CrClor =90 ml/min. When soluble tumor necrosis factor receptor (sTNFR) I and II levels were added into this model individually, the observed OR for women with CrCl60 ml/min was attenuated. In analyses stratified by estimated CrCl, higher high-sensitivity CRP (hs-CRP), IL-6, and sTNFR I and II levels each were significantly associated with an increased odds of coronary events in women with an estimated CrClor =74 ml/min but not in women with an estimated CrClor =75 ml/min. The OR per 5-mg/L unit increase in hs-CRP was 1.68 (95% CI, 1.13 to 2.52) for women with an estimated CrClor =74 ml/min, compared with 1.23 (95% CI, 0.86 to 1.76) and 0.99 (95% CI, 0.76 to 1.29) for women with an estimated CrCl 75 to 89 andor =90 ml/min, respectively (P = 0.004 for interaction). In conclusion, kidney dysfunction is associated with an increased odds of coronary events, and inflammation, as assessed by higher sTNFR I and II levels, may mediate some of this risk. Higher inflammatory biomarkers levels, specifically, hs-CRP, IL-6, and sTNFR I and II, were significantly associated with coronary events only in women with reduced kidney function. These findings warrant further investigation in other populations. |
| Databáze: | OpenAIRE |
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