Affiliation:
1. Department of Internal Medicine College of Medicine Institute of Kidney Disease Research Yonsei University Seoul Korea
2. Division of Nephrology Department of Internal Medicine National Health Insurance Service Medical CenterIlsan Hospital Goyang‐si Gyeonggi‐do Korea
3. Department of Internal Medicine Seoul National University Seoul Korea
4. Department of Prevention and Management School of Medicine Inha University Incheon Korea
5. Department of Internal Medicine Gachon University, Gil Hospital Incheon Korea
6. Department of Internal Medicine Seoul St. Mary's Hospital The Catholic University of Korea Seoul Korea
7. Department of Internal Medicine Chonnam National University Medical School Gwangju Korea
Abstract
Background
The function of high‐density lipoprotein can change from protective to proatherosclerotic under inflammatory conditions. Herein, we studied whether inflammation could modify the relationship between high‐density lipoprotein level and risk of adverse outcomes in patients with chronic kidney disease .
Methods and Results
In total, 1864 patients from the prospective KNOW‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) were enrolled. The main predictor was high‐density lipoprotein cholesterol (HDL‐C) level. Presence of inflammation was defined by hs‐CRP (high‐sensitivity C‐reactive protein) level of ≥1.0 mg/L. The primary outcome was extended major adverse cardiovascular events. During 9231.2 person‐years of follow‐up, overall incidence of the primary outcome was 15.8 per 1000 person‐years. In multivariable Cox analysis after adjusting for confounders, HDL‐C level was not associated with the primary outcome. There was a significant interaction between the inflammatory status and HDL‐C for risk of extended major adverse cardiovascular events (
P
=0.003). In patients without inflammation, the hazard ratios (HRs) (95% CIs) for HDL‐C levels <40, 50 to 59, and ≥60 mg/dL were 1.10 (0.50–1.82), 0.95 (0.50–1.82), and 0.42 (0.19–0.95), respectively, compared with HDL‐C of 40 to 49 mg/dL. However, the significant association for HDL‐C ≥60 mg/dL was not seen after Bonferroni correction. In patients with inflammation, we observed a trend toward increased risk of extended major adverse cardiovascular events in higher HDL‐C groups (HRs [95% CIs], 0.73 [0.37–1.43], 1.24 [0.59–2.61], and 1.56 [0.71–3.45], respectively), but without statistical significance.
Conclusions
The association between HDL‐C level and adverse cardiovascular outcomes showed reverse trends based on inflammation status in Korean patients with chronic kidney disease.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01630486.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
11 articles.
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