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SHR Neuro Cancer Cardio Lipid Metab Microb

Zewinger, S; Speer, T; Kleber, ME; Scharnagl, H; Woitas, R; Lepper, PM; Pfahler, K; Seiler, S; Heine, GH; März, W; Silbernagel, G; Fliser, D.
HDL cholesterol is not associated with lower mortality in patients with kidney dysfunction.
J Am Soc Nephrol. 2014; 25(5):1073-1082 Doi: 10.1681/ASN.2013050482 [OPEN ACCESS]
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Co-authors Med Uni Graz: März Winfried; Scharnagl Hubert; Silbernagel Günther
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Abstract:: In the general population, HDL cholesterol (HDL-C) is associated with reduced cardiovascular events. However, recent experimental data suggest that the vascular effects of HDL can be heterogeneous. We examined the association of HDL-C with all-cause and cardiovascular mortality in the Ludwigshafen Risk and Cardiovascular Health study comprising 3307 patients undergoing coronary angiography. Patients were followed for a median of 9.9 years. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. The effect of increasing HDL-C serum levels was assessed using Cox proportional hazard models. In participants with normal kidney function (eGFR>90 ml/min per 1.73 m(2)), higher HDL-C was associated with reduced risk of all-cause and cardiovascular mortality and coronary artery disease severity (hazard ratio [HR], 0.51, 95% confidence interval [95% CI], 0.26-0.92 [P=0.03]; HR, 0.30, 95% CI, 0.13-0.73 [P=0.01]). Conversely, in patients with mild (eGFR=60-89 ml/min per 1.73 m(2)) and more advanced reduced kidney function (eGFR<60 ml/min per 1.73 m(2)), higher HDL-C did not associate with lower risk for mortality (eGFR=60-89 ml/min per 1.73 m(2): HR, 0.68, 95% CI, 0.45-1.04 [P=0.07]; HR, 0.84, 95% CI, 0.50-1.40 [P=0.50]; eGFR<60 ml/min per 1.73 m(2): HR, 1.18, 95% CI, 0.60-1.81 [P=0.88]; HR, 0.82, 95% CI, 0.40-1.69 [P=0.60]). Moreover, Cox regression analyses revealed interaction between HDL-C and eGFR in predicting all-cause and cardiovascular mortality (P=0.04 and P=0.02, respectively). We confirmed a lack of association between higher HDL-C and lower mortality in an independent cohort of patients with definite CKD (P=0.63). In summary, higher HDL-C levels did not associate with reduced mortality risk and coronary artery disease severity in patients with reduced kidney function. Indeed, abnormal HDL function might confound the outcome of HDL-targeted therapies in these patients. Copyright © 2014 by the American Society of Nephrology.
Find related publications in this database (using NLM MeSH Indexing): Aged -; Cardiovascular Diseases - blood Cardiovascular Diseases - complications Cardiovascular Diseases - mortality; Cholesterol, HDL - blood; Coronary Angiography -; Female -; Follow-Up Studies -; Follow-Up Studies - epidemiology; Humans -; Male -; Middle Aged -; Predictive Value of Tests -; Prospective Studies -; Receptor, Epidermal Growth Factor - blood Receptor, Epidermal Growth Factor - physiology; Renal Insufficiency, Chronic - blood Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - mortality