Kidney Research Institute.
Division of Cardiology, Department of Medicine, and.
Clin J Am Soc Nephrol. 2020 Jan 7;15(1):47-60. doi: 10.2215/CJN.07320619. Epub 2019 Dec 12.
Triglyceride-rich lipoproteins may contribute to the high cardiovascular risk of patients with CKD. This study evaluated associations of apo-B and markers of triglyceride-rich lipoproteins with cardiovascular events in people with CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Analyses were conducted in 9270 participants with CKD in the Study of Heart and Renal Protection (SHARP): 6245 not on dialysis (mean eGFR 26.5 ml/min per 1.73 m), and 3025 on dialysis when recruited. Cox regression methods were used to evaluate associations of lipids with incident atherosclerotic and nonatherosclerotic vascular events, adjusting for demographics and clinical characteristics. Hazard ratios (HRs) were calculated per 1 SD higher level for apo-B, HDL cholesterol, LDL cholesterol, triglyceride-rich lipoprotein cholesterol (, total cholesterol minus LDL cholesterol minus HDL cholesterol), non-HDL cholesterol, log triglyceride, and log ratio of triglyceride to HDL cholesterol.
During a median follow-up of 4.9 years (interquartile range, 4.0-5.5 years), 1406 participants experienced at least one atherosclerotic vascular event. In multivariable adjusted models, positive associations with atherosclerotic vascular events were observed for apo-B (HR per 1 SD, 1.19; 95% confidence interval, 1.12 to 1.27), triglycerides (1.06; 1.00 to 1.13), the ratio of triglyceride to HDL cholesterol (1.10; 1.03 to 1.18), and triglyceride-rich lipoprotein cholesterol (1.14; 1.05 to 1.25). By contrast, inverse associations with nonatherosclerotic vascular events were observed for each of these lipid markers: apo-B (HR per 1 SD, 0.92; 0.85 to 0.98), triglycerides (0.86; 0.81 to 0.92), the ratio of triglyceride to HDL cholesterol (0.88; 0.82 to 0.94), and triglyceride-rich lipoprotein cholesterol (0.85; 0.77 to 0.94).
Higher apo-B, triglycerides, ratio of triglyceride to HDL cholesterol, and triglyceride-rich lipoprotein cholesterol concentrations were associated with increased risk of atherosclerotic vascular events in CKD. Reducing triglyceride-rich lipoproteins using novel therapeutic agents could potentially lower the risk of atherosclerotic cardiovascular disease risk in the CKD population.
富含甘油三酯的脂蛋白可能导致 CKD 患者心血管风险升高。本研究评估了载脂蛋白 B 和富含甘油三酯脂蛋白标志物与 CKD 患者心血管事件的相关性。
设计、地点、参与者和测量：在心脏和肾脏保护研究（SHARP）中对 9270 名 CKD 患者进行了分析：6245 名未接受透析（平均 eGFR 26.5 ml/min/1.73 m），3025 名在招募时接受透析。使用 Cox 回归方法评估了血脂与动脉粥样硬化和非动脉粥样硬化血管事件的相关性，调整了人口统计学和临床特征。每升高 1 SD，载脂蛋白 B、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、富含甘油三酯脂蛋白胆固醇（总胆固醇减去低密度脂蛋白胆固醇减去高密度脂蛋白胆固醇）、非高密度脂蛋白胆固醇、甘油三酯对数和甘油三酯与高密度脂蛋白胆固醇的比值的风险比（HR）均进行计算。
在中位随访 4.9 年（四分位间距，4.0-5.5 年）期间，1406 名患者发生了至少一次动脉粥样硬化性血管事件。在多变量调整模型中，载脂蛋白 B（每升高 1 SD 的 HR，1.19；95%置信区间，1.12 至 1.27）、甘油三酯（1.06；1.00 至 1.13）、甘油三酯与高密度脂蛋白胆固醇的比值（1.10；1.03 至 1.18）和富含甘油三酯的脂蛋白胆固醇（1.14；1.05 至 1.25）与动脉粥样硬化性血管事件呈正相关。相比之下，这些脂质标志物与非动脉粥样硬化性血管事件呈负相关：载脂蛋白 B（每升高 1 SD 的 HR，0.92；0.85 至 0.98）、甘油三酯（0.86；0.81 至 0.92）、甘油三酯与高密度脂蛋白胆固醇的比值（0.88；0.82 至 0.94）和富含甘油三酯的脂蛋白胆固醇（0.85；0.77 至 0.94）。
较高的载脂蛋白 B、甘油三酯、甘油三酯与高密度脂蛋白胆固醇的比值和富含甘油三酯的脂蛋白胆固醇浓度与 CKD 患者的动脉粥样硬化性血管事件风险增加相关。使用新型治疗药物降低富含甘油三酯的脂蛋白可能会降低 CKD 人群的动脉粥样硬化性心血管疾病风险。
