Authors
Lazutkina A. Yu.
MD, PhD, Leading inspector-physician, Department of Organization of Medical Care1
1 - Far Eastern Directorate of Healthcare – a structural subdivision of the Central Directorate of Healthcare – a branch of Russian Railways, Khabarovsk, Russian Federation
Corresponding Author
Lazutkina Anna; e-mail: Lazutkina_AU59@mail.ru
Funding
The study had no sponsorship.
Conflict of interest
None declared.
Abstract
Introduction. Studying the influence of risk factors (RF) for cardiovascular diseases (CVD) is a promising direction, since reducing their degree of influence can lead to an increase in overall life expectancy. The least studied of the RFs are confounders. Aim. To find out the influence of confounders in the chain of events of the cardiorenal continuum (CRC) using the example of a group of initially healthy 7,959 male workers of locomotive crews of the Trans-Baikal Railway aged 18-66 years. Materials and methods. Using 22 items of clinical and anamnestic data of a 6-year follow-up of a natural professional population of 7,959 men, multivariate statistical analysis was used to determine predictors of microalbuminuria (MAU), creatininemia (CR), reduced glomerular filtration rate (GFR), retinopathy (RP) and sudden cardiac death (SCD), which made it possible to construct a CRC from the prepared symptomatic blocks applying the synthesis method. The Cox proportional hazard model was used to determine the influence of all predictors of these symptoms on the increased risk of consecutive CRC events. The time of formation of MAU, RP, CR, reduced GFR, SCD, and the stages of endothelial dysfunction was found out using Kaplan-Meier (K-M) curves. The effects of damage to the endothelium by RFs, including confounders, were assessed by «failures» in K-M models. Results. Depending on the place of implementation in the CRC vascular bed, confounders manifest themselves by synergistic/additive and stabilizing processes caused by them in the endothelium. 1. They increase the risk of cardiovascular disease (CVD) / target organ damage (TOD) and the number of «failures» of the outcome being studied; 2. They increase the risk of CVD/TOD, but do not affect the number of «failures» of the outcome being studied; 3. They do not affect the increase in the risk of CVD/TOD, but increase the number of «failures» of the studied outcome; 4. They are associated with CVD/TOD, but do not affect the increase in risk and increase in the number of «failures» of the outcome being studied. Conclusion. Confounders of the CRC have four types of destructive effects. It is necessary to conduct targeted biochemical and morphological studies in order to finally clarify the processes of damage in the endothelium caused by risk factors and confounders and to resist their influence before the irreversible changes occur in the endothelial cell.
Key words
risk factors, confounders, chronic kidney disease, continuum, sudden cardiac death, endothelial dysfunction
DOI
References
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