Division of Nephrology and Hypertension Harold Simmons Center for Kidney Disease Research and Epidemiology University of California Irvine Medical Center Orange CA.
Nephrology Section Tibor Rubin Veterans Affairs Medical Center Long Beach CA.
J Am Heart Assoc. 2021 Dec 7;10(23):e022988. doi: 10.1161/JAHA.121.022988. Epub 2021 Nov 3.
Background High triglycerides are associated with atherosclerotic cardiovascular disease (ASCVD) risks. Among patients with advanced chronic kidney disease (CKD), the association of elevated triglycerides with mortality is diminished and, thus, we investigated the relationship of triglycerides with ASCVD and non-ASCVD hospitalizations across CKD stages. Methods and Results The cohort comprised 2 963 176 veterans who received care in 2004 to 2006 (baseline) and were followed up to 2014. Using Cox models, we evaluated baseline and time-varying triglycerides with time to ASCVD or non-ASCVD hospitalizations, stratified by baseline CKD stage, and adjusted for demographics and baseline or time-updated clinical characteristics. The cohort mean±SD age was 63±14 years, with a baseline median (interquartile range) triglycerides level of 127 (87-189) mg/dL, and a quarter had prevalent CKD. There was a linear association between baseline triglycerides and ASCVD risk; however, the risk with high triglycerides ≥240 mg/dL attenuated with worsening CKD stages (reference: triglycerides 120 to <160 mg/dL). Baseline triglycerides were associated with a U-shaped relationship for non-ASCVD events in patients with CKD 3A to 3B. Patients with late-stage CKD had lower to null relationships between baseline triglycerides and non-ASCVD events. Time-varying triglycerides associations with ASCVD were similar to baseline analyses. Yet, the time-varying triglycerides relationship with non-ASCVD events was inverse and linear, where elevated triglycerides were associated with lower risks. Conclusions Associations of higher triglycerides with ASCVD and non-ASCVD events declined across advancing CKD stages, where a lower to null risk was observed in patients with advanced CKD. Studies are needed to examine the impact of advanced CKD on triglycerides metabolism and its association with outcomes in this high-risk population.
高甘油三酯与动脉粥样硬化性心血管疾病（ASCVD）风险相关。在患有晚期慢性肾脏病（CKD）的患者中，升高的甘油三酯与死亡率之间的关联减弱，因此，我们研究了甘油三酯与 CKD 各阶段 ASCVD 和非 ASCVD 住院之间的关系。
该队列包括 2963176 名在 2004 年至 2006 年（基线）期间接受治疗的退伍军人，并随访至 2014 年。我们使用 Cox 模型评估了基线和时变甘油三酯与 ASCVD 或非 ASCVD 住院的时间，按基线 CKD 分期分层，并调整了人口统计学和基线或时间更新的临床特征。队列的平均年龄为 63±14 岁，基线中位数（四分位距）甘油三酯水平为 127（87-189）mg/dL，四分之一的患者患有 CKD。基线甘油三酯与 ASCVD 风险呈线性关联；然而，随着 CKD 分期的恶化，高甘油三酯（≥240mg/dL）的风险减弱（参考：甘油三酯 120 至<160mg/dL）。在 CKD 3A 至 3B 期患者中，基线甘油三酯与非 ASCVD 事件呈 U 形关系。晚期 CKD 患者的基线甘油三酯与非 ASCVD 事件之间的关系较低甚至为零。时变甘油三酯与 ASCVD 的关联与基线分析相似。然而，时变甘油三酯与非 ASCVD 事件的关系呈负相关和线性，其中升高的甘油三酯与较低的风险相关。
随着 CKD 的进展，较高甘油三酯与 ASCVD 和非 ASCVD 事件的关联减弱，在晚期 CKD 患者中观察到较低甚至为零的风险。需要研究来检查晚期 CKD 对甘油三酯代谢的影响及其在这一高危人群中与结局的关系。
