Background: Obesity is associated with higher end-stage renal disease incidence, but associations with earlier forms of kidney disease remain incompletely characterized. Methods: We studied the association of body mas...Background: Obesity is associated with higher end-stage renal disease incidence, but associations with earlier forms of kidney disease remain incompletely characterized. Methods: We studied the association of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with rapid kidney function decline and incident chronic kidney disease in 4573 non-diabetic adults with eGFR ≥ 60 ml/min/1.73m2 at baseline from longitudinal Multi-Ethnic Study of Atherosclerosis cohort. Kidney function was estimated by creatinine and cystatin C. Multivariate analysis was adjusted for age, race, baseline eGFR, and hypertension. Results: Mean age was 60 years old, BMI 28 kg/m2, baseline eGFRCr 82 and eGFRCys 95 ml/min/1.73m2. Over 5 years of follow up, 25% experienced rapid decline in renal function by eGFRCr and 22% by eGFRCys. Incident chronic kidney disease (CKD) developed in 3.3% by eGFRCys, 11% by eGFRCr, and 2.4% by both makers. Compared to persons with BMI 25, overweight (BMI 25 - 30) persons had the?lowest risk of rapid decline by eGFRCr (0.84, 0.71 - 0.99). In contrast, higher BMI categories were associated with stepwise higher odds of rapid decline by eGFRCys, but remained significant only when BMI ≥ 35 kg/m2 (1.87, 1.41 - 2.48). Associations of BMI with incident CKD were insignificant after adjustment. Large WC and WHR were associated with increased risk of rapid decline only by eGFRCys, and of incident CKD only when defined by both filtration markers. Conclusions: Obesity may be a risk factor for kidney function decline, but associations vary by filtration marker used.展开更多
Background -Sympathetic activation influences the risk of ventricular arrhythmias and sudden cardiac death(SCD), mediated in part by the β2-adrenergic receptor(B2AR). We investigated whether variation in the B2AR gen...Background -Sympathetic activation influences the risk of ventricular arrhythmias and sudden cardiac death(SCD), mediated in part by the β2-adrenergic receptor(B2AR). We investigated whether variation in the B2AR gene is associated with SCD risk. Methods and Results -In this study, 4441 white and 808 black Cardiovascular Health Study(CHS) participants were followed up prospectively for SCD and genotyped for B2AR Gly16Arg and Gln27Glu polymorphisms. The study was replicated in 155 case and 144 control white subjects in a population-based case-control study of SCD, the Cardiac Arrest Blood Study(CABS). In CHS, Gly 16 and Gln27 allele frequencies were 62.4%and 57.1%among white and 50.1%and 81.4%among black participants. Over a median follow-up of 11.1 years, 156 and 39 SCD events occurred in white and black participants, respectively. The Gln27Glu variant was associated with SCD risk(P=0.008 for general model). SCD risk was higher in Gln27 homozygous participants than in Glu27 carriers(ethnicity-adjusted hazard ratio[HR], 1.56; 95%confidence interval[CI], 1.17 to 2.09; P=0.003). The increased risk did not differ significantly between white(HR, 1.62; 95%CI, 1.18 to 2.23) and black(HR, 1.23; 95%CI, 0.61 to 2.48) participants, although the confidence interval was wide in blacks. In the CABS replication study, Gln27 homozygous participants similarly had higher SCD risk than Glu27 carriers(odds ratio, 1.64; 95%CI, 1.02 to 2.63; P=0.040). Gly16Arg was not associated with SCD risk in either study. Conclusions -Gln27 homozygous individuals have an increased risk of SCD in 2 study populations. Our findings suggest that B2AR plays a role in SCD in humans. Study of genetic variation within the B2AR gene may help identify those at increased SCD risk.展开更多
文摘Background: Obesity is associated with higher end-stage renal disease incidence, but associations with earlier forms of kidney disease remain incompletely characterized. Methods: We studied the association of body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) with rapid kidney function decline and incident chronic kidney disease in 4573 non-diabetic adults with eGFR ≥ 60 ml/min/1.73m2 at baseline from longitudinal Multi-Ethnic Study of Atherosclerosis cohort. Kidney function was estimated by creatinine and cystatin C. Multivariate analysis was adjusted for age, race, baseline eGFR, and hypertension. Results: Mean age was 60 years old, BMI 28 kg/m2, baseline eGFRCr 82 and eGFRCys 95 ml/min/1.73m2. Over 5 years of follow up, 25% experienced rapid decline in renal function by eGFRCr and 22% by eGFRCys. Incident chronic kidney disease (CKD) developed in 3.3% by eGFRCys, 11% by eGFRCr, and 2.4% by both makers. Compared to persons with BMI 25, overweight (BMI 25 - 30) persons had the?lowest risk of rapid decline by eGFRCr (0.84, 0.71 - 0.99). In contrast, higher BMI categories were associated with stepwise higher odds of rapid decline by eGFRCys, but remained significant only when BMI ≥ 35 kg/m2 (1.87, 1.41 - 2.48). Associations of BMI with incident CKD were insignificant after adjustment. Large WC and WHR were associated with increased risk of rapid decline only by eGFRCys, and of incident CKD only when defined by both filtration markers. Conclusions: Obesity may be a risk factor for kidney function decline, but associations vary by filtration marker used.
文摘Background -Sympathetic activation influences the risk of ventricular arrhythmias and sudden cardiac death(SCD), mediated in part by the β2-adrenergic receptor(B2AR). We investigated whether variation in the B2AR gene is associated with SCD risk. Methods and Results -In this study, 4441 white and 808 black Cardiovascular Health Study(CHS) participants were followed up prospectively for SCD and genotyped for B2AR Gly16Arg and Gln27Glu polymorphisms. The study was replicated in 155 case and 144 control white subjects in a population-based case-control study of SCD, the Cardiac Arrest Blood Study(CABS). In CHS, Gly 16 and Gln27 allele frequencies were 62.4%and 57.1%among white and 50.1%and 81.4%among black participants. Over a median follow-up of 11.1 years, 156 and 39 SCD events occurred in white and black participants, respectively. The Gln27Glu variant was associated with SCD risk(P=0.008 for general model). SCD risk was higher in Gln27 homozygous participants than in Glu27 carriers(ethnicity-adjusted hazard ratio[HR], 1.56; 95%confidence interval[CI], 1.17 to 2.09; P=0.003). The increased risk did not differ significantly between white(HR, 1.62; 95%CI, 1.18 to 2.23) and black(HR, 1.23; 95%CI, 0.61 to 2.48) participants, although the confidence interval was wide in blacks. In the CABS replication study, Gln27 homozygous participants similarly had higher SCD risk than Glu27 carriers(odds ratio, 1.64; 95%CI, 1.02 to 2.63; P=0.040). Gly16Arg was not associated with SCD risk in either study. Conclusions -Gln27 homozygous individuals have an increased risk of SCD in 2 study populations. Our findings suggest that B2AR plays a role in SCD in humans. Study of genetic variation within the B2AR gene may help identify those at increased SCD risk.
