Specific lipid phenotype linked to CHD risk among chronic kidney disease patients
A characteristic lipid phenotype consisting of triglyceride-rich lipoproteins appears to be strongly associated with the risk of developing coronary heart disease (CHD) among patients with chronic kidney disease (CKD), a study reports.
Researchers followed 6,612 individuals for a median of 8.5 years for the development of CHD (defined as incident myocardial infarction, angina followed by revascularisation, resuscitated cardiac arrest or CHD death). There were 577 (9 percent) who had CKD (estimated glomerular filtration rate [eGFR], 15 to <60 mL/min/1.73 m2; stages 3–4).
CHD occurred with greater frequency in the CKD group than in the non-CKD group (12 percent vs 5 percent; p<0.001). Principal component analyses revealed that a dyslipidaemic phenotype (principal component 1 [PC1])was more common in the CKD group than in those without CKD (p<0.001).
The said phenotype consisted of elevated triglycerides, triglyceride-rich lipoproteins (very low-density lipoprotein [LDL] particles) and small LDL particles, as well as reductions in high-density lipoprotein (HDL) particles.
This PC1 phenotype was more strongly associated with CHD risk among patients with CKD, such that each standard deviation increase in PC1 was associated with a 51-percent increased risk in the CKD group (HR, 1.51; 95 percent CI, 1.17–1.94; p<0.001) vs a 13-percent increased risk in the non-CKD group (HR, 1.13;1.00-1.27; p=0.05).
The present data suggest that in addition to statins, novel nonstatin therapies targeting the main dyslipidaemic phenotype present in moderate CKD may prove useful in reducing the significant cardiovascular burden in individuals with CKD.
More work is needed to investigate whether modification of the components of the PC1 phenotype leads to a reduction in the CHD burden in individuals with CKD, researchers said.
A potential mechanism underlying the observed dyslipidaemic pattern of CKD is that of insulin resistance, which has been reported to be an early metabolic alteration in CKD and independent of diabetes and obesity in the present population.