Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
CGH Medical Center, Sterling, Illinois, USA,
Cardiorenal Med. 2019;9(6):400-407. doi: 10.1159/000502511. Epub 2019 Aug 26.
Dyslipidemia in kidney disease (KD) involves increased levels of triglycerides (TG) and TG-rich lipoproteins, with only minor changes in low-density lipoprotein cholesterol. The increasing prevalence of diabetic KD and the shared atherogenic lipid profile between KD and diabetes underscore the importance of understanding dyslipidemia in these patients. Previous studies suggest an association between elevated TG and new-onset KD. Additional data are needed to better define the relationship between hypertriglyceridemia and new-onset KD.
To evaluate the real-world impact of elevated and high TG on risk of KD in high-risk statin-treated patients.
This retrospective administrative claims analysis of the Optum Research Database included statin-treated patients (age ≥45 years) with diabetes and/or atherosclerotic cardiovascular disease who were followed for ≥6 months. Cohorts included patients with elevated TG (≥150 mg/dL; n = 27,471) or high TG (200-499 mg/dL; subgroup of elevated TG cohort; n = 13,411), and a comparator cohort (TG <150 mg/dL and high-density lipoprotein cholesterol >40 mg/dL; n = 32,506). The probability of hospitalization for new-onset KD was calculated post hoc from multivariate analyses controlled for patient characteristics and comorbidities using a Cox proportional hazards model.
The rate of hospitalization for new-onset KD was 31% higher in the elevated-TG cohort (hazard ratio [HR], 1.311; 95% confidence interval [CI], 1.228-1.401; p < 0.001) and 45% higher in the high-TG cohort (HR, 1.451; 95% CI, 1.339-1.572; p < 0.001) compared with the respective comparator cohorts.
In a real-world analysis of statin-treated patients with high cardiovascular risk, both elevated TG (≥150 mg/dL) and high TG (200-499 mg/dL) were significant predictors of hospitalization for new-onset KD, identifying hypertriglyceridemia as a potential KD risk factor.
肾病中的血脂异常包括甘油三酯（TG）和富含 TG 的脂蛋白水平升高，而低密度脂蛋白胆固醇只有轻微变化。糖尿病肾病的患病率不断上升，以及肾病和糖尿病之间存在共同的致动脉粥样硬化脂质谱，这突显了了解这些患者血脂异常的重要性。先前的研究表明，TG 升高与新诊断的肾病有关。需要更多的数据来更好地定义高甘油三酯血症与新发肾病之间的关系。
评估升高和高 TG 对高危他汀类药物治疗患者新发肾病风险的实际影响。
这是一项回顾性的 Optum Research 数据库行政索赔分析，纳入了接受他汀类药物治疗（年龄≥45 岁）且患有糖尿病和/或动脉粥样硬化性心血管疾病的患者，这些患者的随访时间≥6 个月。队列包括 TG 升高（≥150mg/dL；n=27471）或高 TG（200-499mg/dL；升高 TG 队列的亚组；n=13411）患者，以及对照组（TG＜150mg/dL 且高密度脂蛋白胆固醇＞40mg/dL；n=32506）。使用 Cox 比例风险模型，根据患者特征和合并症对多变量分析进行事后控制，计算新诊断肾病住院的概率。
与相应的对照组相比，升高 TG 队列的新诊断肾病住院率高出 31%（危险比[HR]，1.311；95%置信区间[CI]，1.228-1.401；p＜0.001），高 TG 队列的新诊断肾病住院率高出 45%（HR，1.451；95%CI，1.339-1.572；p＜0.001）。
在一项针对高心血管风险的他汀类药物治疗患者的真实世界分析中，升高的 TG（≥150mg/dL）和高 TG（200-499mg/dL）都是新发肾病住院的显著预测因素，表明高甘油三酯血症可能是肾病的一个危险因素。
