Decreased GFR and its joint association with type 2 diabetes and hypertension with prevalence and severity of carotid plaque in a community population in China
Received 20 February 2019
Accepted for publication 29 May 2019
Published 26 July 2019 Volume 2019:12 Pages 1263—1273
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Konstantinos Tziomalos
Qianzi Che,1 Ying Yang,2 Guanliang Cheng,2 Jia Jia,2 Fangfang Fan,2 Jianping Li,2 Yong Huo,2 Dafang Chen,1 Yan Zhang2
1Department of Epidemiology & Biostatistics, Peking University Health Science Center, Beijing, People’s Republic of China; 2Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
Background: Type 2 diabetes (T2DM), hypertension and kidney dysfunction are known risk factors for cardiovascular disease, but their combined effect on carotid plaque remains uncertain. This study aims to assess the associations between T2DM, hypertension, kidney dysfunction and carotid plaque, and further explore the combined effect of three diseases.
Patients and methods: We conducted a cross-sectional analysis among 3,815 community-dwelling adults in a Chinese atherosclerosis cohort. Estimated glomerular filtration rate (eGFR), hypertension and T2DM were evaluated as risk factors for carotid plaque. The presence, number and total area of carotid plaques were also assessed. Using logistic model, mutinomial logistic model and generalized linear regression model, the relationship between risk factors and carotid plaque was examined.
Results: T2DM, hypertension, decreased GFR, and, inversely, eGFR, were independently associated with the presence, number and total area of carotid plaque. Stratified analysis by T2DM and hypertension showed T2DM attenuated the association between eGFR change and carotid plaque. There was a cumulative relationship between three risk factors and carotid plaque burden. The OR for the number of plaques was 1.0 (reference), 1.55 to 2.03, 1.94 to 3.14, and 3.69 (all P<0.05), respectively, for individuals with none, one, two, and three risk factors. Likewise, combining three risk factors was associated with greater increase in total plaque area (β, 20.63; 95% CI, 14.04–27.22).
Conclusion: The coexistence of decreased GFR, diabetes and hypertension is associated with increased risk of carotid plaque, and these comorbidities may contribute additively to the development of plaque.
Keywords: joint association, decreased GFR, T2DM, hypertension, carotid plaque
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