Egfr Of Analysis, And Coronary Heart Disease

Objective:1.To review the estimated glomerular filtration(eGFR) and traditional risk factors for coronary artery disease(CAD) in patients who underwent coronary angiography for suspected CAD.2.To investigate the relationship between decrease in eGFR with obstructive CAD in the same cohort.3.To discuss the relationship betwween eGFR and the severity of coronary artery stenosis in the same cohort.Methods:1.As a retrospective cross sectional study,we enrolled in patients who underwent coronary angiography the first time in cardiology department of Huashan Hospital from January 1^st,2006 to February 29^th,2008 excluding those who had a clearly history of CAD,urinary infection,heart failure malignant tumor,rheumatic disease and renal failure or dialysis. 2.Demographic and clinical characteristics(including sex,age,height, weight,use of antihypertensive and cholesterol lowering drugs,smoking status,family history of premature CAD) were recorded.Blood pressure was measured at early morning.Blood samples were obtained in the next morning after fasting for at least 8 hours at night for the test of FBG,TC,TG,HDL-C,LDL-C,serum creatinine.The eGFR was estimated from serum creatinine using the abbreviated Modification of Diet in Renal Disease equation.3.Normal renal function was diagnosed if the eGFR was≥90 ml/min/1.73 m².Mild renal insufficiency was diagnosed if the eGFR was 60 to 89 ml/min/1.73 m².Moderate or severe renal insufficiency was diagnosed if the eGFR was 15 to 59 ml/min/1.73 m².4.Obstructive CAD was diagnosed if a patient had＞50%narrowing of≥1 coronary artery.5. Database was established with Microsoft 2003.6.All analyses were performed with SPSS 15.0.Results:1.657 patients underwent coronary angiography were enrolled.Of the 657 patients,410 had CAD and 247 didn't have CAD。Average eGFR of CAD patients was significantly lower than that of non-CAD patients(P=0.004).2.Patients were divided to three groups according to the value of eGFR as mentioned previously.The percentage of elderly patients in three groups were 58.5%,79.2%,96.2%,respectively and of patients with hypertension were 62.5%,71.9%,86.8%.The patients were significantly older and more of them were with hypertension in the group with moderate or severe renal insufficiency and mild renal insufficiency compared with the group with normal renal function.The level of systolic blood pressure(SBP) was negatively correlated with the level of eGFR(r=-0.082, P=0.036) as well as after controlling for the effects of smoking,BMI, dyslipidemia,HDL-C,diabetes and family history of premature CAD (r=-0.O87,P=0.026).On the contrary,the level of HDL-C was positively correlated with the level of eGFR(r=0.O84,P=0.008) as well as after controlling for the effects of smoking,elder,BMI,hypertension, dyslipidemia,systolic blood pressure,diabetes and family history of premature CAD(r=0.095,P=0.016).3.Patients with eGFR less than 60 ml/min/1.73 m²(OR=2.176,95%CI:1.120 -4.266) had an increased risk of CAD compared with those with eGFR more than 60 ml/min/1.73 m².Logistic regression models were used to assess the association of renal insufficiency with CAD in patients with hypertension, in which elder,diabetes,smoking,dyslipidemia,family history of premature CAD were listed as covariates.Smoking(OR=1.840),diabetes (OR=1.865),elder(OR=2.537),mild renal insufficiency(OR=1.563), moderate or severe renal insufficiency(OR=2.350)entered the model,which were all of statistical significance.4.Setting the median value of SBP as well as eGFR as cut points,all patients were divided into SBP＜125mmHg and eGFR≥88ml/min/1.73m² group, SBP＜125mmHg and e1FR＜88ml/min/1.73m² group,SBP≥125mmHg and eGFR≥88 ml/min/1.73m² group,SBP≥125mmHg and eGFR＜88m1/min/1.73m² group.The percentage of CAD in the four groups were 57.2%,64.6%,57.2%,70.2%, respectively.The patients with SBP≥125mmHg and eGFR＜88ml/min/1.73m² (P=0.011) had a significantly increased percentage of CAD compared with those with SBP≥125mmHg and eGFR≥88 ml/min/1.73m².5.Setting the median value of HDL-C as well as eGFR as cut points,all patients were divided into HDL-C≥1.1mmol/L and eGFR≥88 ml/min/1.73 m² group,HDL-C≥1.1mmol/L and eGFR＜88 ml/min/1.73m² group,HDL-C＜1.1mmol/L and eGFR≥88ml/min/1.73m² group,HDL-C＜1.1mmol/L and eGFR＜88 ml/min/1.73 m² group.The percentage of CAD in the four groups were 52.0%,60.8%,62.9%, 74.0%,respectively.The patients with HDL-C≥1.1mmol/L and eGFR＜88 ml/min/1.73m²(P=0.100),HDL-C＜1.1mmol/L and eGFR≥88 ml/min/1.73 m² (P=0.040),HDL-C＜1.1mmol/L and eGFR＜88 ml/min/1.73 m²(P＜0.001) tended to have a increased percentage of CAD compared with patients with HDL-C≥1.1mmol/L and eGFR≥88 ml/min/1.73 m².6.All patients were divided according to the extent of atherosclerosis of the coronary artery into three groups.The average eGFR of three groups tended to decrease with the atherosclerotic plaque formation.The difference of average eGFR between patients without coronary artery atherosclerosis and patients with CAD was of statistical significance (P=0.002).Patients were also divided into groups with non-CAD,1-,2-, multi-vessel CAD with coronary arteries narrowed＞50%.Patients with non-CAD,1-,2-vessel CAD had a higher level of average eGFR compared with patients with multi-vessel CAO(P＜0.001,0.001,0.005,respectively).The level of average eGFR tended to decrease with the increased narrowed coronary arteries.7.Logistic regression analysis showed that patients with a moderate or severe decrease in eGFR had a 3.2 times higher chance of having multivessel CAD after controlling for the effects of age,sex,BMI,smoking, hypertension,dyslipidemia,diabetes and family history of premature CAD(OR=3.207,P＜0.001).8.The level of Gensini score which reflected the severity of coronary artery stenosis was negatively correlated with the level of eGFR (r=-0.159,P＜0.001) as well as after controlling for the effects of smoking,elder,hypertension,dyslipidemia,use of antihypertensive and cholesterol lowering drugs,diabetes and family history of premature CAD(r=-0.110,P=0.005).Conclusion:This study show renal insufficiency was one of the CVD risk factors as well as elder,smoking,diabetes and hypertension,especially in patients with hypertension.The Gensini score associated with the severity of coronary artery stenosis is negatively correlated with the level of eGFR.eGFR＜60ml/min/1.73m² is an independent risk factor for multi-vessel CAD.It suggests that we should pay more attention to the patients with renal insufficiency about CAD prevention.