Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2020 Apr 9;15(4):e0231328. doi: 10.1371/journal.pone.0231328. eCollection 2020.
The association of lipid parameters with cardiovascular outcomes and the impact of kidney function on this association have not been thoroughly evaluated in chronic kidney disease (CKD) patients with diabetes. We reviewed the National Health Insurance Database of Korea, containing the data of 10,505,818 subjects who received routine check-ups in 2009. We analyzed the association of lipid profile parameters with major adverse cardiovascular events (MACEs) risk and all-cause mortality in a nationally representative cohort of 51,757 lipid-lowering medication-naïve patients who had CKD and diabetes. Advanced CKD patients with eGFR <30 mL/min/1.73 m2 (n = 10,775) had lower serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) but higher non-HDL-c levels and triglyceride (TG) to HDL-c ratios. There was a positive linear association between serum LDL-c and MACE risk in both early and advanced CKD patients (P <0.001 for trend), except for the category of LDL-c 30-49 mg/dL in extremely low LDL-c subgroup analyses. A U-shaped relationship was observed between serum LDL-c and all-cause mortality (the 4th and 8th octile groups; lowest hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 and highest HR 1.14, 95% CI 1.04-1.26, respectively). A similar pattern remained in both early and advanced CKD patients. The TG/HDL-c ratio categories showed a positive linear association for MACE risk in early CKD (P <0.001 for trend), but this correlation disappeared in advanced CKD patients. There was no correlation between the serum TG/HDL-c ratio and all-cause mortality in the study patients. The LDL-c level predicted the risk for MACEs and all-cause mortality in both early and advanced CKD patients with diabetes, although the patterns of the association differed from each other. However, the TG/HDL-c ratio categories could not predict the risk for either MACEs or all-cause mortality in advanced CKD patients with diabetes, except that the TG/HDL-c ratio predicted MACE risk in early CKD patients with diabetes.
脂质参数与心血管结局的关系以及肾功能对这种关系的影响在患有糖尿病的慢性肾脏病 (CKD) 患者中尚未得到充分评估。我们回顾了韩国国民健康保险数据库,其中包含了 2009 年接受常规检查的 10505818 名受试者的数据。我们分析了脂质谱参数与主要不良心血管事件 (MACE) 风险和全因死亡率的关系,该研究纳入了 51757 名未使用降脂药物的、患有 CKD 和糖尿病的、具有全国代表性的队列中的患者。eGFR <30 mL/min/1.73 m2 的晚期 CKD 患者(n=10775)的血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)和高密度脂蛋白胆固醇(HDL-c)水平较低,但非高密度脂蛋白胆固醇(non-HDL-c)和甘油三酯(TG)与高密度脂蛋白胆固醇(HDL-c)的比值较高。血清 LDL-c 与早期和晚期 CKD 患者的 MACE 风险呈正线性相关(趋势 P<0.001),但在 LDL-c 极低亚组分析中,LDL-c 30-49 mg/dL 这一类别除外。血清 LDL-c 与全因死亡率之间存在 U 型关系(第 4 位和第 8 位 8 分位数组;最低风险比 [HR]0.96,95%置信区间 [CI]0.87-1.05 和最高 HR1.14,95%CI1.04-1.26)。这种模式在早期和晚期 CKD 患者中均保持一致。早期 CKD 患者中,TG/HDL-c 比值类别与 MACE 风险呈正线性相关(趋势 P<0.001),但在晚期 CKD 患者中这种相关性消失。在研究患者中,血清 TG/HDL-c 比值与全因死亡率之间无相关性。LDL-c 水平可预测早期和晚期 CKD 合并糖尿病患者的 MACEs 和全因死亡率风险,尽管其关联模式彼此不同。然而,TG/HDL-c 比值类别不能预测晚期 CKD 合并糖尿病患者的 MACEs 或全因死亡率风险,除了 TG/HDL-c 比值可预测早期 CKD 合并糖尿病患者的 MACE 风险。