Low levels of high-density lipoprotein cholesterol: an independent risk factor for late adverse cardiovascular events in renal transplant recipients

Abstract Background Sclerostin is a hormone contributing to the bone-vascular wall cross talk and has been implicated in cardiovascular events and mortality in patients with chronic kidney disease (CKD). We analyzed the relationship between sclerostin and mortality in renal transplant recipients. Methods 600 stable renal transplant recipients (367men, 233 women) were followed for all-cause mortality for 3 years. Blood and urine samples for analysis and clinical data were collected at study entry. We performed Kaplan–Meier survival analysis and Cox regression models considering confounding factors such as age, eGFR, cold ischemia time, HbA1c, phosphate, calcium, and albumin. Optimal cut-off values for the Cox regression model were calculated based on ROC analysis. Results Sixty-five patients died during the observation period. Nonsurvivors (n = 65; sclerostin 57.31 ± 30.28 pmol/L) had higher plasma sclerostin levels than survivors (n = 535; sclerostin 47.52 ± 24.87 pmol/L) (p = 0.0036). Kaplan–Meier curve showed that baseline plasma sclerostin concentrations were associated with all-cause mortality in stable kidney transplant recipients (p = 0.0085, log-rank test). After multiple Cox regression analysis, plasma levels of sclerostin remained an independent predictor of all-cause mortality (hazard ratio, 1.011; 95% CI 1.002–1.020; p = 0.0137). Conclusions Baseline plasma sclerostin is an independent risk factor for all-cause mortality in patients after kidney transplantation.

Download Full-text

High-Density Lipoprotein Particles and Their Relationship to Posttransplantation Diabetes Mellitus in Renal Transplant Recipients

Biomolecules ◽

10.3390/biom10030481 ◽

2020 ◽

Vol 10 (3) ◽

pp. 481

Author(s):

Sara Sokooti ◽

Tamas Szili-Torok ◽

Jose L. Flores-Guerrero ◽

Maryse C. J. Osté ◽

António W. Gomes-Neto ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Transplant ◽

High Density Lipoprotein ◽

Lower Risk ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

High Density ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Cox Regression Analysis

High concentrations of high-density lipoprotein (HDL) cholesterol are likely associated with a lower risk of posttransplantation diabetes mellitus (PTDM). However, HDL particles vary in size and density with yet unestablished associations with PTDM risk. The aim of our study was to determine the association between different HDL particles and development of PTDM in renal transplant recipients (RTRs). We included 351 stable outpatient adult RTRs without diabetes at baseline evaluation. HDL particle characteristics and size were measured by nuclear magnetic resonance (NMR) spectroscopy. During 5.2 (IQR, 4.1‒5.8) years of follow-up, 39 (11%) RTRs developed PTDM. In multivariable Cox regression analysis, levels of HDL cholesterol (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40–0.94 per 1SD increase; p = 0.024) and of large HDL particles (HR 0.68, 95% CI 0.50–0.93 per log 1SD increase; p = 0.017), as well as larger HDL size (HR 0.58, 95% CI 0.36–0.93 per 1SD increase; p = 0.025) were inversely associated with PTDM development, independently of relevant covariates including, age, sex, body mass index, medication use, transplantation-specific parameters, blood pressure, triglycerides, and glucose. In conclusion, higher concentrations of HDL cholesterol and of large HDL particles and greater HDL size were associated with a lower risk of PTDM development in RTRs, independently of established risk factors for PTDM development.

Download Full-text

Low Levels of High-Density Lipoprotein Cholesterol and Increased Risk of Cardiovascular Events in Stable Ischemic Heart Disease Patients

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.07.051 ◽

2013 ◽

Vol 62 (20) ◽

pp. 1826-1833 ◽

Cited By ~ 60

Author(s):

Subroto Acharjee ◽

William E. Boden ◽

Pamela M. Hartigan ◽

Koon K. Teo ◽

David J. Maron ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

High Density Lipoprotein ◽

High Density Lipoprotein Cholesterol ◽

Cardiovascular Events ◽

Density Lipoprotein ◽

Ischemic Heart ◽

Lipoprotein Cholesterol ◽

Increased Risk ◽

Low Levels

Download Full-text

Role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant recipients

International Journal of Clinical Trials ◽

10.18203/2349-3259.ijct20180133 ◽

2018 ◽

Vol 5 (1) ◽

pp. 67 ◽

Cited By ~ 1

Author(s):

Shraddha Goswami ◽

Achal Sepaha ◽

Mukesh Dube ◽

Abhishek Singh ◽

Bhavani Mohan Raju ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Renal Transplant ◽

Plasminogen Activator ◽

Cardiovascular Events ◽

Homocysteine Level ◽

Plasma Homocysteine ◽

Renal Transplant Recipients ◽

Transplant Recipients

Background: Traditional risk factors like elevated homocysteine levels may not completely explain the higher CVD seen in RTRs. Identification and optimisation of modifiable risk factors may help to reduce the occurrence of CVD in such population. To study the role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant patients. Another objective was to evaluate the other risk factors in the occurrence of CVD in such population.Methods: Thirty renal transplant recipients and thirty healthy controls were studied. Inclusion criteria were transplant duration >6 months and patients with chronic stable renal function over the last 3 months. Samples for fasting plasma homocysteine were collected and plasma homocysteine was then estimated. All the patients were followed up every month for 6 months and evaluated for occurrence of any cardiovascular event.Results: The mean hornocysteine levels were found to be 27.4±7.902 µmol/L in cases and 10.86±1.98 µmol/L in controls. There was no statistically significant relationship between homocysteine levels and transplant duration, mean IMT levels, proteinuria, and presence of left ventricular hypertrophy or choice of immunosuppressive regimen. Of the 30 patients, 6 patients (20%) had evidence of cardiovascular event. In the absence of other conventional factors, age of the patient, creatinine clearance (index of graft function) and mean intima-media thickness were more closely related with cardiovascular events. Conclusions: Plasma homocysteine failed to show as an independent risk factor for cardiovascular events. New, emerging cardiovascular risk factors (e.g. Lipoprotein (a), high sensitivity C-reactive protein, fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1) should be studied to design effective therapy to delay the progression of atherosclerosis and prolong the life of renal transplant recipients.

Download Full-text