Carotid atherosclerotic disease predicts cardiovascular events in hemodialysis patients : a prospective study
Collado, S (Hospital del Mar (Barcelona, Catalunya))
Coll Piera, Elisabeth (Institut d'Investigació Biomèdica Sant Pau)
Nicolau, Carlos (Hospital Clínic i Provincial de Barcelona)
Pons, Mercedes (Fresenius Medical Care (Barcelona))
Cruzado, Josep María (Institut Hemodiàlisi Barcelona)
Pascual, Julio (Hospital del Mar (Barcelona, Catalunya))
Cases Amenós, Aleix (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Data:	2015
Resum:	Background: To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients. Methods: Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT <0. 9 mm, 2) IMT >0. 9 mm, 3) carotid plaque with stenosis <50% and 4) plaque with stenosis >50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed. Results: 83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29. 1% of patients experienced cardiovascular events, and 28. 2% died, 38. 7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0. 03) while calcified plaques were associated with both cardiovascular events (p = 0. 01), cardiovascular mortality (p = 0. 03) and non-significantly with overall mortality (p = 0. 08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2. 27, 95% CI 1. 13-4. 54), age (HR 1. 04, 1. 01-1. 06), previous cardiovascular disease (HR 1. 75, 1. 05-4. 42), dyslipidemia (HR 2. 25, 1. 11-4. 53), lipoprotein (a) (HR 1. 01, 1. 00-1. 02), troponin I (HR 3. 89, 1. 07-14. 18), fibrinogen levels (HR 1. 38, 0. 98-1. 94) and antiplatelet therapy (HR 2. 14, 1. 04-4. 4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3. 29, 1. 52-7. 15) and lipoprotein (a) (HR 1. 01, 1. 00-1. 02). Conclusions: The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Adult ; Aged ; Cardiovascular Diseases ; Carotid Artery Diseases ; Carotid Intima-Media Thickness ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Prospective Studies ; Renal Dialysis
Publicat a:	PloS one, Vol. 10 Núm. 6 (january 2015) , p. e0127344, ISSN 1932-6203

DOI: 10.1371/journal.pone.0127344
PMID: 26029907

12 p, 480.8 KB

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