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Non-high-density lipoprotein cholesterol: a target of lipid-lowering in dialysis patients.
Am J Kidney Dis 2003; 41(3 Suppl 1):S72-5AJ

Abstract

BACKGROUND

The finding of an increased prevalence and levels of atherogenic lipoproteins in the context of normal plasma total and low-density lipoprotein (LDL) cholesterol (LDL-C) levels in hemodialysis (HD) patients highlights the need to look beyond the basic assessment of plasma concentrations of total cholesterol and LDL-C. Measurement of atherogenic lipoproteins (remnant lipoprotein particles [RLPs], particularly intermediate-density lipoprotein [IDL]), is not routinely performed at the present time.

METHODS

The National Cholesterol Education Program guidelines indicate that the secondary goal in persons with triglyceride levels greater than 200 mg/dL is non-high-density lipoprotein cholesterol (HDL-C). Non-HDL-C comprises all RLPs, including IDL, as well as atherogenic small dense LDL.

RESULTS

We propose, for practical reasons, that non-HDL-C be used as a primary target in HD patients when lipid-lowering therapy is indicated. However, it remains unclear whether and how effective statins are in lowering remnant particle levels in dialysis patients. Recent data show that both simvastatin and atorvastatin reduce non-HDL-C levels effectively. Atorvastatin preferentially reduces RLP levels in patients with combined hyperlipidemia.

CONCLUSION

The safety profile of statins predisposes prescription of this class of drugs to correct dyslipidemia or modulate lipoprotein particle composition in uremic patients. Whether atorvastatin influences myocardial infarction or all-cause mortality by adequately correcting dyslipidemia should be seen fairly quickly in the 1,252 dialysis patients with diabetes randomly assigned in the ongoing Die Deutsche Diabetes Dialyse study.

Authors+Show Affiliations

Department of Medicine, Division of Nephrology, University of Würzburg, Germany. wanner_c@medizin.uni-wuerzburg.deNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

12612957

Citation

Wanner, Christoph, and Vera Krane. "Non-high-density Lipoprotein Cholesterol: a Target of Lipid-lowering in Dialysis Patients." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 41, no. 3 Suppl 1, 2003, pp. S72-5.
Wanner C, Krane V. Non-high-density lipoprotein cholesterol: a target of lipid-lowering in dialysis patients. Am J Kidney Dis. 2003;41(3 Suppl 1):S72-5.
Wanner, C., & Krane, V. (2003). Non-high-density lipoprotein cholesterol: a target of lipid-lowering in dialysis patients. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 41(3 Suppl 1), pp. S72-5.
Wanner C, Krane V. Non-high-density Lipoprotein Cholesterol: a Target of Lipid-lowering in Dialysis Patients. Am J Kidney Dis. 2003;41(3 Suppl 1):S72-5. PubMed PMID: 12612957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-high-density lipoprotein cholesterol: a target of lipid-lowering in dialysis patients. AU - Wanner,Christoph, AU - Krane,Vera, PY - 2003/3/4/pubmed PY - 2003/3/15/medline PY - 2003/3/4/entrez SP - S72 EP - 5 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 41 IS - 3 Suppl 1 N2 - BACKGROUND: The finding of an increased prevalence and levels of atherogenic lipoproteins in the context of normal plasma total and low-density lipoprotein (LDL) cholesterol (LDL-C) levels in hemodialysis (HD) patients highlights the need to look beyond the basic assessment of plasma concentrations of total cholesterol and LDL-C. Measurement of atherogenic lipoproteins (remnant lipoprotein particles [RLPs], particularly intermediate-density lipoprotein [IDL]), is not routinely performed at the present time. METHODS: The National Cholesterol Education Program guidelines indicate that the secondary goal in persons with triglyceride levels greater than 200 mg/dL is non-high-density lipoprotein cholesterol (HDL-C). Non-HDL-C comprises all RLPs, including IDL, as well as atherogenic small dense LDL. RESULTS: We propose, for practical reasons, that non-HDL-C be used as a primary target in HD patients when lipid-lowering therapy is indicated. However, it remains unclear whether and how effective statins are in lowering remnant particle levels in dialysis patients. Recent data show that both simvastatin and atorvastatin reduce non-HDL-C levels effectively. Atorvastatin preferentially reduces RLP levels in patients with combined hyperlipidemia. CONCLUSION: The safety profile of statins predisposes prescription of this class of drugs to correct dyslipidemia or modulate lipoprotein particle composition in uremic patients. Whether atorvastatin influences myocardial infarction or all-cause mortality by adequately correcting dyslipidemia should be seen fairly quickly in the 1,252 dialysis patients with diabetes randomly assigned in the ongoing Die Deutsche Diabetes Dialyse study. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/12612957/Non_high_density_lipoprotein_cholesterol:_a_target_of_lipid_lowering_in_dialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272638603000179 DB - PRIME DP - Unbound Medicine ER -