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Lipid profiles and risk of major adverse cardiovascular events in CKD and diabetes: A nationwide population-based study.
PLoS One. 2020; 15(4):e0231328.Plos

Abstract

The association of lipid parameters with cardiovascular outcomes and the impact of kidney function on this association have not been thoroughly evaluated in chronic kidney disease (CKD) patients with diabetes. We reviewed the National Health Insurance Database of Korea, containing the data of 10,505,818 subjects who received routine check-ups in 2009. We analyzed the association of lipid profile parameters with major adverse cardiovascular events (MACEs) risk and all-cause mortality in a nationally representative cohort of 51,757 lipid-lowering medication-naïve patients who had CKD and diabetes. Advanced CKD patients with eGFR <30 mL/min/1.73 m2 (n = 10,775) had lower serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) but higher non-HDL-c levels and triglyceride (TG) to HDL-c ratios. There was a positive linear association between serum LDL-c and MACE risk in both early and advanced CKD patients (P <0.001 for trend), except for the category of LDL-c 30-49 mg/dL in extremely low LDL-c subgroup analyses. A U-shaped relationship was observed between serum LDL-c and all-cause mortality (the 4th and 8th octile groups; lowest hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 and highest HR 1.14, 95% CI 1.04-1.26, respectively). A similar pattern remained in both early and advanced CKD patients. The TG/HDL-c ratio categories showed a positive linear association for MACE risk in early CKD (P <0.001 for trend), but this correlation disappeared in advanced CKD patients. There was no correlation between the serum TG/HDL-c ratio and all-cause mortality in the study patients. The LDL-c level predicted the risk for MACEs and all-cause mortality in both early and advanced CKD patients with diabetes, although the patterns of the association differed from each other. However, the TG/HDL-c ratio categories could not predict the risk for either MACEs or all-cause mortality in advanced CKD patients with diabetes, except that the TG/HDL-c ratio predicted MACE risk in early CKD patients with diabetes.

Authors+Show Affiliations

Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea.Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea. Department of Internal Medicine, Armed Forces Capital Hospital, Gyeonggi-do, Korea. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Pub Type(s)

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

Language

eng

PubMed ID

32271842

Citation

Lee, Yeonhee, et al. "Lipid Profiles and Risk of Major Adverse Cardiovascular Events in CKD and Diabetes: a Nationwide Population-based Study." PloS One, vol. 15, no. 4, 2020, pp. e0231328.
Lee Y, Park S, Lee S, et al. Lipid profiles and risk of major adverse cardiovascular events in CKD and diabetes: A nationwide population-based study. PLoS One. 2020;15(4):e0231328.
Lee, Y., Park, S., Lee, S., Kim, Y., Kang, M. W., Cho, S., Park, S., Han, K., Kim, Y. C., Han, S. S., Lee, H., Lee, J. P., Joo, K. W., Lim, C. S., Kim, Y. S., & Kim, D. K. (2020). Lipid profiles and risk of major adverse cardiovascular events in CKD and diabetes: A nationwide population-based study. PloS One, 15(4), e0231328. https://doi.org/10.1371/journal.pone.0231328
Lee Y, et al. Lipid Profiles and Risk of Major Adverse Cardiovascular Events in CKD and Diabetes: a Nationwide Population-based Study. PLoS One. 2020;15(4):e0231328. PubMed PMID: 32271842.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lipid profiles and risk of major adverse cardiovascular events in CKD and diabetes: A nationwide population-based study. AU - Lee,Yeonhee, AU - Park,Sehoon, AU - Lee,Soojin, AU - Kim,Yaerim, AU - Kang,Min Woo, AU - Cho,Semin, AU - Park,Sanghyun, AU - Han,Kyungdo, AU - Kim,Yong Chul, AU - Han,Seoung Seok, AU - Lee,Hajeong, AU - Lee,Jung Pyo, AU - Joo,Kwon Wook, AU - Lim,Chun Soo, AU - Kim,Yon Su, AU - Kim,Dong Ki, Y1 - 2020/04/09/ PY - 2019/10/22/received PY - 2020/03/20/accepted PY - 2020/4/10/entrez PY - 2020/4/10/pubmed PY - 2020/7/10/medline SP - e0231328 EP - e0231328 JF - PloS one JO - PLoS One VL - 15 IS - 4 N2 - The association of lipid parameters with cardiovascular outcomes and the impact of kidney function on this association have not been thoroughly evaluated in chronic kidney disease (CKD) patients with diabetes. We reviewed the National Health Insurance Database of Korea, containing the data of 10,505,818 subjects who received routine check-ups in 2009. We analyzed the association of lipid profile parameters with major adverse cardiovascular events (MACEs) risk and all-cause mortality in a nationally representative cohort of 51,757 lipid-lowering medication-naïve patients who had CKD and diabetes. Advanced CKD patients with eGFR <30 mL/min/1.73 m2 (n = 10,775) had lower serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) but higher non-HDL-c levels and triglyceride (TG) to HDL-c ratios. There was a positive linear association between serum LDL-c and MACE risk in both early and advanced CKD patients (P <0.001 for trend), except for the category of LDL-c 30-49 mg/dL in extremely low LDL-c subgroup analyses. A U-shaped relationship was observed between serum LDL-c and all-cause mortality (the 4th and 8th octile groups; lowest hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 and highest HR 1.14, 95% CI 1.04-1.26, respectively). A similar pattern remained in both early and advanced CKD patients. The TG/HDL-c ratio categories showed a positive linear association for MACE risk in early CKD (P <0.001 for trend), but this correlation disappeared in advanced CKD patients. There was no correlation between the serum TG/HDL-c ratio and all-cause mortality in the study patients. The LDL-c level predicted the risk for MACEs and all-cause mortality in both early and advanced CKD patients with diabetes, although the patterns of the association differed from each other. However, the TG/HDL-c ratio categories could not predict the risk for either MACEs or all-cause mortality in advanced CKD patients with diabetes, except that the TG/HDL-c ratio predicted MACE risk in early CKD patients with diabetes. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/32271842/Lipid_profiles_and_risk_of_major_adverse_cardiovascular_events_in_CKD_and_diabetes:_A_nationwide_population_based_study_ DB - PRIME DP - Unbound Medicine ER -