Abstract P120: Relationship of Lipoproteins With Cardiovascular Disease in Persons With Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is associated with dyslipidemia (particularly elevated triglycerides [TG] and reduced HDL-cholesterol [HDL-C]) and increased risk of atherosclerotic cardiovascular disease (CVD). However, the association between lipoprotein measures and CVD events in CKD is not well defined. Hypothesis: We hypothesize that high TG and low HDL-C are associated with increased risk for CVD (myocardial infarction [MI] and ischemic stroke) in CKD. Methods: The Chronic Renal Insufficiency Cohort (CRIC) is a prospective study of adults with CKD. We compared tertiles of TG, total cholesterol (TC), VLDL-cholesterol (VLDL-C), LDL-cholesterol (LDL-C), HDL-C, apolipoprotein B (apoB), and apolipoprotein A-I (apoA-I) with risk for MI and ischemic stroke using Fine and Gray methods with death as a competing risk. The lowest tertile was used as the reference category except for HDL-C and apoA-I, in which the highest tertile was used. In secondary analyses, we excluded participants with previous MI or stroke. Results: Among 3811 participants (55% men, 42% Caucasian) with mean age 57.7±11.0 years, 351 had an MI, 132 had an ischemic stroke, and 963 died over a median follow-up of 7.9 years. After adjusting for potential confounders, the hazard ratio (HR, 95% CI) for CVD was 1.04 (0.80-1.34) for high LDL-C, 1.31 (1.01-1.69) for high TG, 1.33 (1.04-1.70) for high VLDL-C, 1.30 (1.01-1.68) for high apoB, 1.65 (1.25-2.17) for low HDL-C, and 1.31 (1.01-1.70) for low apoA-I. In secondary analyses of 2751 participants with no CVD history, high TG (HR 1.46, 1.02-2.10), high VLDL-C (HR 1.56, 1.08-2.25), low HDL-C (HR 2.11, 1.40-3.16) and low apoA-I (HR 2.28, 1.54-3.37) were significantly associated with incident CVD. Conclusions: While high LDL-C is associated with increased CVD risk in the general population, we found no such association in CKD. Instead, high TG, high VLDL-C, low HDL-C and low apoA-I levels show strong associations with increased CVD risk and incident CVD events in CKD.

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Low statin use in nondialysis-dependent chronic kidney disease in the absence of clinical atherosclerotic cardiovascular disease or diabetes

Clinical Kidney Journal ◽

10.1093/ckj/sfy131 ◽

2019 ◽

Vol 12 (4) ◽

pp. 530-537

Author(s):

Talar W Markossian ◽

Holly J Kramer ◽

Nicholas J Burge ◽

Ivan V Pacold ◽

David J Leehey ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Atherosclerotic Cardiovascular Disease ◽

Risk Equation ◽

Diabetes Status ◽

Increased Risk ◽

Ascvd Risk ◽

Risk Equivalent ◽

Statin Use

Abstract Background Both reduced glomerular filtration rate and increased urine albumin excretion, markers of chronic kidney disease (CKD), are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). However, CKD is not recognized as an ASCVD risk equivalent by most lipid guidelines. Statin medications, especially when combined with ezetimibe, significantly reduce ASCVD risk in patients with nondialysis-dependent CKD. Unless physicians recognize the heightened ASCVD risk in this population, statins may not be prescribed in the absence of clinical cardiovascular disease or diabetes, a recognized ASCVD risk equivalent. We examined statin use in adults with nondialysis-dependent CKD and examined whether the use differed in the presence of clinical ASCVD and diabetes. Methods This study ascertained statin use from pharmacy dispensing records during fiscal years 2012 and 2013 from the US Department of Veterans Affairs Healthcare System. The study included 581 344 veterans aged ≥50 years with nondialysis-dependent CKD Stages 3–5 with no history of kidney transplantation or dialysis. The 10-year predicted ASCVD risk was calculated with the pooled risk equation. Results Of veterans with CKD, 62.1% used statins in 2012 and 55.4% used statins continuously over 2 years (2012–13). Statin use in 2012 was 76.2 and 75.5% among veterans with CKD and ASCVD or diabetes, respectively, but in the absence of ASCVD, diabetes or a diagnosis of hyperlipidemia, statin use was 21.8% (P < 0.001). The 10-year predicted ASCVD risk was ≥7.5% in 95.1% of veterans with CKD, regardless of diabetes status. Conclusions Statin use is low in veterans with nondialysis-dependent CKD in the absence of ASCVD or diabetes despite high-predicted ASCVD risk. Future studies should examine other populations.

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Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease

Kidney International ◽

10.1016/j.kint.2016.08.009 ◽

2016 ◽

Vol 90 (6) ◽

pp. 1348-1356 ◽

Cited By ~ 14

Author(s):

Nisha Bansal ◽

Charles E. McCulloch ◽

Feng Lin ◽

Cassianne Robinson-Cohen ◽

Mahboob Rahman ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Atherosclerotic Cardiovascular Disease ◽

Advanced Chronic Kidney Disease ◽

Increased Risk

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Epicardial Adipose Tissue, Adiponectin and Leptin: A Potential Source of Cardiovascular Risk in Chronic Kidney Disease

International Journal of Molecular Sciences ◽

10.3390/ijms21030978 ◽

2020 ◽

Vol 21 (3) ◽

pp. 978 ◽

Cited By ~ 3

Author(s):

Luis D’Marco ◽

Maria Jesús Puchades ◽

Jose Luis Gorriz ◽

Maria Romero-Parra ◽

Marcos Lima-Martínez ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Adipose Tissue ◽

Cardiovascular Risk ◽

Kidney Disease ◽

General Population ◽

Epicardial Adipose Tissue ◽

Atherosclerotic Cardiovascular Disease ◽

Increased Risk ◽

The Impact

The importance of cardiometabolic factors in the inception and progression of atherosclerotic cardiovascular disease is increasingly being recognized. Beyond diabetes mellitus and metabolic syndrome, other factors may be responsible in patients with chronic kidney disease (CKD) for the high prevalence of cardiovascular disease, which is estimated to be 5- to 20-fold higher than in the general population. Although undefined uremic toxins are often blamed for part of the increased risk, visceral adipose tissue, and in particular epicardial adipose tissue (EAT), have been the focus of intense research in the past two decades. In fact, several lines of evidence suggest their involvement in atherosclerosis development and its complications. EAT may promote atherosclerosis through paracrine and endocrine pathways exerted via the secretion of adipocytokines such as adiponectin and leptin. In this article we review the current knowledge of the impact of EAT on cardiovascular outcomes in the general population and in patients with CKD. Special reference will be made to adiponectin and leptin as possible mediators of the increased cardiovascular risk linked with EAT.

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Statins for Renal Patients: A Fiddler on the Roof?

International Journal of Nephrology ◽

10.1155/2012/806872 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Anabela Malho Guedes ◽

Pedro Leão Neves

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Renal Disease ◽

Cardiovascular Events ◽

Morbidity And Mortality ◽

Atherosclerotic Cardiovascular Disease ◽

Increased Risk ◽

Progression Of Renal Disease

Atherosclerotic cardiovascular disease is the main cause of morbidity and mortality in chronic kidney disease patients. There is a raft of evidence showing that in the general population dyslipidaemia is associated with an increased risk of cardiovascular events, as well as with a greater prevalence of chronic kidney disease. Consequently, the use of statins in the general population with dyslipidaemia is not controversial. Nevertheless, the benefits of statins in patients with chronic kidney disease are more elusive. The authors review the possible effects of statins on the progression of renal disease and cardiovascular events in chronic kidney disease patients.

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Stentul JJ ureteral - care este optiunea mai buna? New Considerations Regarding Chronic Kidney Disease, Cardiovascular Disease and Dyslipidemia in Diabetic Patients

Revista de Chimie ◽

10.37358/rc.18.8.6474 ◽

2018 ◽

Vol 69 (8) ◽

pp. 2064-2066

Author(s):

Mircea Munteanu ◽

Adrian Apostol ◽

Viviana Ivan

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Total Cholesterol ◽

Total Cholesterol Level ◽

Vascular Complications ◽

Hdl Cholesterol ◽

Controlled Study ◽

Diabetic Patients ◽

Artery Disease

The aim of the present study is to investigate the prevalance of chronic kidney disease (CKD), of cardiovascular disease (CVD) and dyslipidemia in patients with diabetes mellitus (DM). We conducted a prospective, controlled study involving 420 diabetic patients (120 T1DM, 300 T2DM) and investigate the following aspects: the presence of vascular complications (stroke, coronary artery disease, peripheral artery disease), lipid profile (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides), kidney function (glomerular filtration rate, albuminuria), blood pressure, HbA1C. The results that in diabetic patients with CKD there is an increased prevalence of CVD and of dislipidemia. Also we noticed a negative correlation between total cholesterol level and decease in eGFR in all patients, with or without CKD.

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Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease

Cardiovascular Diabetology ◽

10.1186/s12933-021-01247-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Demetria Hubbard ◽

Lisandro D. Colantonio ◽

Robert S. Rosenson ◽

Todd M. Brown ◽

Elizabeth A. Jackson ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Health Insurance ◽

High Risk ◽

Kidney Disease ◽

Peripheral Artery ◽

Increased Risk ◽

Patients With Diabetes ◽

Very High

Abstract Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.

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Abstract 16116: Chronic Kidney Disease in HIV Population and Cardiovascular Disease

Circulation ◽

10.1161/circ.142.suppl_3.16116 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Bertrand Ebner ◽

Jelani Grant ◽

Louis Vincent ◽

Quentin Loyd ◽

Catherine Boulanger ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Viral Load ◽

Kidney Disease ◽

Clinical Laboratory ◽

South Florida ◽

Cvd Risk ◽

Comparable Rate ◽

Persons Living With Hiv ◽

Significant Difference

Background: Chronic kidney disease (CKD) is well known to increase the risk of cardiovascular disease (CVD). However, there is limited knowledge about the association between CKD in persons living with HIV (PLWH) and CVD. We sought to investigate the prevalence and characteristics of CVD in PLWH with and without CKD at a large single center in South Florida. Methods: A retrospective chart review of 985 of PLWH from a Special Immunology clinic at a large center in South Florida between 2017-2019 was performed. Data on demographics, clinical, laboratory and diagnostic studies were obtained from electronic health records. Results: The prevalence of CKD in PLWH in our cohort was 11%. The group of CKD was older (58 vs. 51 years p<0.05), with significantly more men (66% vs. 53% p=0.012). The CKD cohort had increased rates of hypertension, coronary artery disease (CAD), heart failure, diabetes mellitus, and cerebrovascular disease (<0.05 for all). PLWH with CKD had a significantly higher HbA1C level, systolic and diastolic blood pressure, statin use, and lower LDL-C (p<0.05 for all). Subjects with HIV and CKD had a higher rate of cardiac catheterization (7.2%), with an increased rate of obstructive CAD (6.3%), when compared to PLWH without CKD (1.3% and 0.7%, respectively, p<0.05 for both). The rate of diastolic dysfunction was significantly higher in PLWH with CKD than those without CKD (p=0.004), although, no difference in ejection fraction (p=0.079) was noted. We found a significantly lower average CD4 count in individuals with HIV and CKD compared to those without CKD (483 ± 297 cells/mm 3 vs. 570 ± 342 cells/mm 3 , p=0.006). No significant difference was noted between groups in mean viral load, proportion with undetectable viral load, and use of antiretroviral medications. Prevalence of chronic hepatitis infection (B and/or C) was also higher in the CKD cohort (p<0.05). Conclusion: In this study, we found a comparable rate of CKD compared to age-matched patients from the general population. We found higher rates of traditional CVD risk factors and disease in the CKD cohort, without significant difference in HIV-related factors. This supports the importance of CVD risk factor optimization in this population.

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