TY - JOUR
T1 - Lipids, Apolipoproteins, and Risk of Atherosclerotic Cardiovascular Disease in Persons With CKD
AU - CRIC Study Investigators
AU - Bajaj, Archna
AU - Xie, Dawei
AU - Cedillo-Couvert, Esteban
AU - Charleston, Jeanne
AU - Chen, Jing
AU - Deo, Rajat
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - He, Jiang
AU - Horwitz, Edward
AU - Kallem, Radhakrishna
AU - Rahman, Mahboob
AU - Weir, Matthew R.
AU - Anderson, Amanda H.
AU - Rader, Daniel J.
AU - Appel, Lawrence J.
AU - Kusek, John W.
AU - Lash, James P.
AU - Rao, Panduranga S.
AU - Townsend, Raymond R.
N1 - Publisher Copyright:
© 2019 National Kidney Foundation, Inc.
PY - 2019/6
Y1 - 2019/6
N2 - Rationale & Objective: A large residual risk for atherosclerotic cardiovascular disease (ASCVD) remains in the setting of chronic kidney disease (CKD) despite treatment with statins. We sought to evaluate the associations of lipid and apolipoprotein levels with risk for ASCVD in individuals with CKD. Study Design: Prospective cohort study. Settings & Participants: Adults aged 21 to 74 years with non–dialysis-dependent CKD at baseline enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study in 7 clinical study centers in the United States. Predictor: Baseline total cholesterol, non–high-density lipoprotein cholesterol (non–HDL-C), very low-density lipoprotein cholesterol (VLDL-C), triglycerides, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo-B), HDL-C, and apolipoprotein AI (Apo-AI) values stratified into tertiles. Outcome: A composite ASCVD event of myocardial infarction or ischemic stroke. Analytic Approach: Multivariable Cox proportional hazards regression to estimate the risk for ASCVD for each tertile of lipoprotein predictor. Results: Among 3,811 CRIC participants (mean age, 57.7 years; 41.8% white), there were 451 ASCVD events during a median follow-up of 7.9 years. There was increased ASCVD risk among participants with VLDL-C levels in the highest tertile (HR, 1.28; 95% CI, 1.01-1.64), Apo-B levels in the middle tertile (HR, 1.30; 95% CI, 1.03-1.64), HDL-C levels in the middle and lowest tertiles (HRs of 1.40 [95% CI, 1.08-1.83] and 1.77 [95% CI, 1.35-2.33], respectively), and Apo-AI levels in the middle and lowest tertiles (HRs of 1.77 [95% CI, 1.02-1.74] and 1.77 [95% CI, 1.36-2.32], respectively). LDL-C level was not significantly associated with the ASCVD outcome in this population (HR, 1.00 [95% CI, 0.77-1.30] for the highest tertile). Limitations: Associations based on observational data do not permit inferences about causal associations. Conclusions: Higher VLDL-C and Apo-B levels, as well as lower HDL-C and Apo-AI levels, are associated with increased risk for ASCVD. These findings support future investigations into pharmacologic targeting of lipoproteins beyond LDL-C, such as triglyceride-rich lipoproteins, to reduce residual risk for ASCVD among individuals with CKD.
AB - Rationale & Objective: A large residual risk for atherosclerotic cardiovascular disease (ASCVD) remains in the setting of chronic kidney disease (CKD) despite treatment with statins. We sought to evaluate the associations of lipid and apolipoprotein levels with risk for ASCVD in individuals with CKD. Study Design: Prospective cohort study. Settings & Participants: Adults aged 21 to 74 years with non–dialysis-dependent CKD at baseline enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study in 7 clinical study centers in the United States. Predictor: Baseline total cholesterol, non–high-density lipoprotein cholesterol (non–HDL-C), very low-density lipoprotein cholesterol (VLDL-C), triglycerides, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo-B), HDL-C, and apolipoprotein AI (Apo-AI) values stratified into tertiles. Outcome: A composite ASCVD event of myocardial infarction or ischemic stroke. Analytic Approach: Multivariable Cox proportional hazards regression to estimate the risk for ASCVD for each tertile of lipoprotein predictor. Results: Among 3,811 CRIC participants (mean age, 57.7 years; 41.8% white), there were 451 ASCVD events during a median follow-up of 7.9 years. There was increased ASCVD risk among participants with VLDL-C levels in the highest tertile (HR, 1.28; 95% CI, 1.01-1.64), Apo-B levels in the middle tertile (HR, 1.30; 95% CI, 1.03-1.64), HDL-C levels in the middle and lowest tertiles (HRs of 1.40 [95% CI, 1.08-1.83] and 1.77 [95% CI, 1.35-2.33], respectively), and Apo-AI levels in the middle and lowest tertiles (HRs of 1.77 [95% CI, 1.02-1.74] and 1.77 [95% CI, 1.36-2.32], respectively). LDL-C level was not significantly associated with the ASCVD outcome in this population (HR, 1.00 [95% CI, 0.77-1.30] for the highest tertile). Limitations: Associations based on observational data do not permit inferences about causal associations. Conclusions: Higher VLDL-C and Apo-B levels, as well as lower HDL-C and Apo-AI levels, are associated with increased risk for ASCVD. These findings support future investigations into pharmacologic targeting of lipoproteins beyond LDL-C, such as triglyceride-rich lipoproteins, to reduce residual risk for ASCVD among individuals with CKD.
KW - Lipids
KW - apolipoprotein
KW - atherosclerotic cardiovascular disease (ASCVD)
KW - chronic kidney disease (CKD)
KW - high-density lipoprotein cholesterol (HDL-C)
KW - ischemic stroke
KW - myocardial infarction (MI)
KW - triglyceride
KW - very low-density lipoprotein cholesterol (VLDL-C)
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U2 - 10.1053/j.ajkd.2018.11.010
DO - 10.1053/j.ajkd.2018.11.010
M3 - Article
C2 - 30686529
AN - SCOPUS:85060347702
SN - 0272-6386
VL - 73
SP - 827
EP - 836
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 6
ER -