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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (6): 1068-1073. doi: 10.19723/j.issn.1671-167X.2023.06.018

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Related factors of endogenous erythropoietin and its association with 10-year risks of cardiovascular disease in a community-based Chinese study

Chu-yun CHEN,Peng-fei SUN,Jing ZHAO,Jia JIA,Fang-fang FAN,Chun-yan WANG,Jian-ping LI,Yi-meng JIANG,Yong HUO,Yan ZHANG*()   

  1. Department of Cardiology, Peking University First Hospital, Beijing 100034, China
  • Received:2021-11-02 Online:2023-12-18 Published:2023-12-11
  • Contact: Yan ZHANG E-mail:drzhy1108@163.com
  • Supported by:
    the National Key Research and Development Program of China(2017YFC1307704);University of Michigan Health System & Peking University Health Science Center Joint Institute Foundation(BMU20110177);University of Michigan Health System & Peking University Health Science Center Joint Institute Foundation(BMU20160530)

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Abstract:

Objective: To investigate the associated factors of endogenous erythropoietin (EPO) and its association with 10-year risks of atherosclerotic cardiovascular disease in a Chinese community-based general population. Methods: The participants of this study were from an atherosclerosis cohort survey which was established by the Department of Cardiology, Peking University First Hospital in 2011. The cohort survey was performed in the Gucheng and Pingguoyuan communities of Shijingshan district in Beijing, China. The inclusion criteria of this study were: (1) endogenous EPO was measured; (2) health questionnaire data and other clinical data were complete; (3) participatants who had cardiovascular or cerebrovascular diseases (defined as self-reported coronary heart disease, stroke or transient ischemic attack) or anemia or estimated glomerular filtration rate (eGFR) < 60 mL/(min·1.73 m2) at baseline were excluded. Multivariate linear regression model was used to examine the associated factors of endogenous EPO. The participants were grouped into low (< 5%), moderate (5%-10%) and high risk (≥10%) groups, based on predicted 10-year cardiovascular disease risk using the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) equations. Results: A total of 4 013 participants were included. Mean age of them was (55.9±8.2) years, 62.2% (n=2 496) of them were female, and 46.3% (n=1 859), 70.9% (n=2 845), 21.9% (n=879) had hypertension, dyslipidemia and diabetes, individually. The average body mass index was (26.1±3.3) kg/m2. The median of EPO level was 12.8 (9.3-17.4) IU/L and 25.1% (n=998) were at high 10-years risk of cardiovascular disease. Hemoglobin (β=-0.05, 95%CI: -0.07 to -0.04) and eGFR ≥90 mL/(min·1.73 m2) (β=-0.05, 95%CI: -0.07 to -0.04) were associated with lower in transformed EPO levels while hypertension (β=0.08, 95%CI: 0.05 to 0.12) and obesity (β=0.14, 95%CI: 0.09 to 0.18) were associated with higher in transformed EPO levels in multivariate linear regression analyses. Ten-year cardiovascular disease risks were positively associated with in transformed EPO levels (β=0.07, 95%CI: 0.05 to 0.09). The participants at moderate and high cardiovascular disease risks had significant higher EPO levels than the low risk group (all P < 0.05). Conclusion: In community-based Beijing populations, endogenous EPO was associated with hemoglobin, renal function, obesity and hypertension. Individuals at high 10-years cardiovascular disease risks have higher endogenous EPO levels. Endogenous EPO may be a potential risk marker of cardiovascular disease.

Key words: Erythropoietin, Cardiovascular disease, Risk, Hypertension, Obesity

CLC Number: 

  • R754

Table 1

Comparison of clinical characteristics of all the subjects (grouped by EPO tertiles)"

Items Low (n=1 338) Moderate (n=1 337) High (n=1 338) χ2/F P
Age/years, ${\bar x}$±s 54.8±7.8 56.1±7.9 56.7±8.7 33.80 < 0.001
Female, n(%) 767 (57.3) 842 (63.0) 887 (66.3) 23.40 < 0.001
Body mass index/(kg/m2), ${\bar x}$±s 25.6±3.2 26.1±3.2 26.5±3.5 57.93 < 0.001
Smoking, n(%) 328 (24.5) 270 (20.2) 233 (17.4) 20.86 < 0.001
Hemoglobin/(g/L), ${\bar x}$±s 137.8±15.0 135.5±14.5 133.0±14.5 71.89 < 0.001
eGFR/[mL/(min·1.73 m2)], ${\bar x}$±s 96.8±10.4 96.0±11.0 95.4±11.8 10.98 0.004
Disease, n(%)
  Hypertension 533 (39.8) 631 (47.2) 695 (51.9) 40.05 < 0.001
  Dyslipidemia 939 (70.2) 947 (70.8) 959 (71.7) 0.73 0.695
  Diabetes 260 (19.4) 285 (21.3) 334 (25.0) 12.37 0.002

Table 2

Univariate and multivariate linear regression results of the related factors of lnEPO"

Variables Univariate Multivariate
β 95% CI P β 95% CI P
Female 0.09 0.05 to 0.12 < 0.001 0.02 -0.03 to 0.07 0.362
Age/years
   < 50 Ref Ref
  50- < 60 0.01 -0.03 to 0.05 0.55 -0.01 -0.05 to 0.03 0.676
  ≥60 0.11 0.07 to 0.16 < 0.001 0.05 -0.00 to 0.10 0.060
Body mass index/(kg/m2)
   < 24 Ref Ref
  24- < 28 0.08 0.04 to 0.12 < 0.001 0.08 0.04 to 0.12 < 0.001
  ≥28 0.15 0.11 to 0.20 < 0.001 0.14 0.09 to 0.18 < 0.001
Hemoglobin/(g/L) -0.05 -0.06 to -0.04 < 0.001 -0.05 -0.07 to -0.04 < 0.001
Smoking -0.09 -0.13 to -0.05 < 0.001 0.00 -0.05 to 0.05 0.979
eGFR/[mL/(min·1.73 m2)]
  60- < 90 Ref Ref
  ≥90 -0.07 -0.11 to -0.03 < 0.001 -0.04 -0.08 to -0.00 0.035
Hypertension 0.11 0.08 to 0.15 < 0.001 0.08 0.05 to 0.12 < 0.001
Diabetes 0.06 0.02 to 0.10 0.002 0.02 -0.02 to 0.07 0.248
Dyslipidemia 0.02 -0.01 to 0.06 0.208 0.00 -0.04 to 0.04 0.992

Figure 1

Comparison of EPO in different 10-year cardiovascular disease risk groups EPO, erythropoietin; * P < 0.05, # P < 0.01, vs. low risk group; Cardiovascular disease risk was calculated, and grouped by the prediction for atherosclerotic cardiovascular disease risk in China equations."

Table 3

Association between 10-year cardiovascular disease risk and lnEPO"

10-year cardiovascular disease risk Model Ⅰ Model Ⅱ
β 95% CI P β 95% CI P
ln(10-year cardiovascular disease risk) 0.04 0.03-0.06 < 0.001 0.07 0.05-0.09 < 0.001
10-year cardiovascular disease risk stratification
Low risk Ref Ref
Moderate risk 0.05 0.01-0.09 0.010 0.09 0.05-0.13 < 0.001
High risk 0.08 0.04-0.12 < 0.001 0.12 0.07-0.16 < 0.001
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