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Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons with CKD.
Clin J Am Soc Nephrol. 2020 01 07; 15(1):47-60.CJ

Abstract

BACKGROUND AND OBJECTIVES

Triglyceride-rich lipoproteins may contribute to the high cardiovascular risk of patients with CKD. This study evaluated associations of apo-B and markers of triglyceride-rich lipoproteins with cardiovascular events in people with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Analyses were conducted in 9270 participants with CKD in the Study of Heart and Renal Protection (SHARP): 6245 not on dialysis (mean eGFR 26.5 ml/min per 1.73 m2), and 3025 on dialysis when recruited. Cox regression methods were used to evaluate associations of lipids with incident atherosclerotic and nonatherosclerotic vascular events, adjusting for demographics and clinical characteristics. Hazard ratios (HRs) were calculated per 1 SD higher level for apo-B, HDL cholesterol, LDL cholesterol, triglyceride-rich lipoprotein cholesterol (i.e., total cholesterol minus LDL cholesterol minus HDL cholesterol), non-HDL cholesterol, log triglyceride, and log ratio of triglyceride to HDL cholesterol.

RESULTS

During a median follow-up of 4.9 years (interquartile range, 4.0-5.5 years), 1406 participants experienced at least one atherosclerotic vascular event. In multivariable adjusted models, positive associations with atherosclerotic vascular events were observed for apo-B (HR per 1 SD, 1.19; 95% confidence interval, 1.12 to 1.27), triglycerides (1.06; 1.00 to 1.13), the ratio of triglyceride to HDL cholesterol (1.10; 1.03 to 1.18), and triglyceride-rich lipoprotein cholesterol (1.14; 1.05 to 1.25). By contrast, inverse associations with nonatherosclerotic vascular events were observed for each of these lipid markers: apo-B (HR per 1 SD, 0.92; 0.85 to 0.98), triglycerides (0.86; 0.81 to 0.92), the ratio of triglyceride to HDL cholesterol (0.88; 0.82 to 0.94), and triglyceride-rich lipoprotein cholesterol (0.85; 0.77 to 0.94).

CONCLUSIONS

Higher apo-B, triglycerides, ratio of triglyceride to HDL cholesterol, and triglyceride-rich lipoprotein cholesterol concentrations were associated with increased risk of atherosclerotic vascular events in CKD. Reducing triglyceride-rich lipoproteins using novel therapeutic agents could potentially lower the risk of atherosclerotic cardiovascular disease risk in the CKD population.

Authors+Show Affiliations

Kidney Research Institute, julio.lampreamontealegre@ucsf.edu. Division of Cardiology, Department of Medicine, and.Medical Research Council Population Health Research Unit and. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Medical Research Council Population Health Research Unit and. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Medical Research Council Population Health Research Unit and. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Medical Research Council Population Health Research Unit and. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Medical Research Council Population Health Research Unit and. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.Kidney Research Institute. Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31831577

Citation

Lamprea-Montealegre, Julio Alejandro, et al. "Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons With CKD." Clinical Journal of the American Society of Nephrology : CJASN, vol. 15, no. 1, 2020, pp. 47-60.
Lamprea-Montealegre JA, Staplin N, Herrington WG, et al. Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons with CKD. Clin J Am Soc Nephrol. 2020;15(1):47-60.
Lamprea-Montealegre, J. A., Staplin, N., Herrington, W. G., Haynes, R., Emberson, J., Baigent, C., & de Boer, I. H. (2020). Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons with CKD. Clinical Journal of the American Society of Nephrology : CJASN, 15(1), 47-60. https://doi.org/10.2215/CJN.07320619
Lamprea-Montealegre JA, et al. Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons With CKD. Clin J Am Soc Nephrol. 2020 01 7;15(1):47-60. PubMed PMID: 31831577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Apolipoprotein B, Triglyceride-Rich Lipoproteins, and Risk of Cardiovascular Events in Persons with CKD. AU - Lamprea-Montealegre,Julio Alejandro, AU - Staplin,Natalie, AU - Herrington,William G, AU - Haynes,Richard, AU - Emberson,Jonathan, AU - Baigent,Colin, AU - de Boer,Ian H, AU - ,, Y1 - 2019/12/12/ PY - 2019/06/22/received PY - 2019/10/18/accepted PY - 2019/12/14/pubmed PY - 2021/6/1/medline PY - 2019/12/14/entrez KW - HDL cholesterol KW - LDL cholesterol KW - apolipoproteins KW - cardiovascular disease KW - cardiovascular diseases KW - cholesterol KW - chronic kidney disease KW - chronic renal insufficiency KW - demography KW - follow-up studies KW - glomerular filtration rate KW - humans KW - lipids KW - lipoprotein cholesterol KW - lipoprotein triglyceride KW - lipoproteins KW - low density lipoprotein triglyceride KW - renal dialysis KW - risk factors KW - triglycerides SP - 47 EP - 60 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 15 IS - 1 N2 - BACKGROUND AND OBJECTIVES: Triglyceride-rich lipoproteins may contribute to the high cardiovascular risk of patients with CKD. This study evaluated associations of apo-B and markers of triglyceride-rich lipoproteins with cardiovascular events in people with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Analyses were conducted in 9270 participants with CKD in the Study of Heart and Renal Protection (SHARP): 6245 not on dialysis (mean eGFR 26.5 ml/min per 1.73 m2), and 3025 on dialysis when recruited. Cox regression methods were used to evaluate associations of lipids with incident atherosclerotic and nonatherosclerotic vascular events, adjusting for demographics and clinical characteristics. Hazard ratios (HRs) were calculated per 1 SD higher level for apo-B, HDL cholesterol, LDL cholesterol, triglyceride-rich lipoprotein cholesterol (i.e., total cholesterol minus LDL cholesterol minus HDL cholesterol), non-HDL cholesterol, log triglyceride, and log ratio of triglyceride to HDL cholesterol. RESULTS: During a median follow-up of 4.9 years (interquartile range, 4.0-5.5 years), 1406 participants experienced at least one atherosclerotic vascular event. In multivariable adjusted models, positive associations with atherosclerotic vascular events were observed for apo-B (HR per 1 SD, 1.19; 95% confidence interval, 1.12 to 1.27), triglycerides (1.06; 1.00 to 1.13), the ratio of triglyceride to HDL cholesterol (1.10; 1.03 to 1.18), and triglyceride-rich lipoprotein cholesterol (1.14; 1.05 to 1.25). By contrast, inverse associations with nonatherosclerotic vascular events were observed for each of these lipid markers: apo-B (HR per 1 SD, 0.92; 0.85 to 0.98), triglycerides (0.86; 0.81 to 0.92), the ratio of triglyceride to HDL cholesterol (0.88; 0.82 to 0.94), and triglyceride-rich lipoprotein cholesterol (0.85; 0.77 to 0.94). CONCLUSIONS: Higher apo-B, triglycerides, ratio of triglyceride to HDL cholesterol, and triglyceride-rich lipoprotein cholesterol concentrations were associated with increased risk of atherosclerotic vascular events in CKD. Reducing triglyceride-rich lipoproteins using novel therapeutic agents could potentially lower the risk of atherosclerotic cardiovascular disease risk in the CKD population. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/31831577/Apolipoprotein_B_Triglyceride_Rich_Lipoproteins_and_Risk_of_Cardiovascular_Events_in_Persons_with_CKD_ DB - PRIME DP - Unbound Medicine ER -