Lipid-related residual risk and renal function for occurrence and prognosis among patients with first-event acute coronary syndrome and normal LDL cholesterol

Lipids in Health and Disease

Ming-Fong Chen¹  Hsiu-Ching Hsu¹  Hung-Ju Lin¹  Kuo-Liong Chien¹ 

[1] Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

关键词: dyslipidemia;    residual risk;    acute coronary syndrome;   

Others  :  1212412
DOI  :  10.1186/1476-511X-10-215

 received in 2011-10-12, accepted in 2011-11-19,  发布年份 2011

【 摘 要 】

Background

We investigated relationship of low levels of high density lipoprotein cholesterol (HDL-C), high levels of triglycerides, and renal function for the odds, prognosis and survival following acute coronary events among patients with a first event and normal low density lipoprotein cholesterol levels.

Results

A case-control study based on 557 patients and 1086 matched control subjects was conducted. Case patients were followed up for survival with a median of 1.9 years. Participants in the higher quintiles of HDL-C had lower odds to develop acute coronary events (the adjusted odds ratios were 0.24 for the second, 0.24 for the third, 0.10 for the fourth and 0.05 for the fifth quintile). Patients with normal glomerular filtration rate were at a lower risk for all-cause death. However, a reverse association between triglycerides and death risk was found: patients with higher triglycerides were at a lower risk for all-cause death (adjusted relative risk, 0.38 for triglycerides ranging from 82 to 132.9 mg/dL, and 0.14 for triglycerides > = 133 mg/dL).

Conclusions

Low HDL-C was significantly associated with acute coronary events, and triglyceride levels as well as renal function were inversely related to all-cause deaths after the coronary event.

【 授权许可】

   
2011 Chien et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 7.

Figure 3.

【 参考文献 】

• [1]Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation 2002, 106(25):3143-3421.
• [2]Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, et al.: European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J 2007, 28(19):2375-2414.
• [3]Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, Fonseca V, Gerstein HC, Grundy S, Nesto RW, et al.: Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007, 115(1):114-126.
• [4]Standards of medical care in diabetes--2008 Diabetes Care 2008, 31(Suppl 1):S12-54.
• [5]Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, et al.: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90, 056 participants in 14 randomised trials of statins. Lancet 2005, 366(9493):1267-1278.
• [6]Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, Armitage J, Baigent C: Efficacy of cholesterol-lowering therapy in 18, 686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008, 371(9607):117-125.
• [7]Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM: Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004, 350(15):1495-1504.
• [8]LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, et al.: Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005, 352(14):1425-1435.
• [9]Carey VJ, Bishop L, Laranjo N, Harshfield BJ, Kwiat C, Sacks FM: Contribution of High Plasma Triglycerides and Low High-Density Lipoprotein Cholesterol to Residual Risk of Coronary Heart Disease After Establishment of Low-Density Lipoprotein Cholesterol Control. The American Journal of Cardiology 2010, 106(6):757-763.
• [10]Fruchart JC, Sacks FM, Hermans MP: Implications of the ACCORD lipid study: perspective from the Residual Risk Reduction Initiative (R(3)i). Curr Med Res Opin 2010, 26(8):1793-1797.
• [11]Wen CP, Cheng TY, Tsai MK, Chang YC, Chan HT, Tsai SP, Chiang PH, Hsu CC, Sung PK, Hsu YH, et al.: All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. Lancet 2008, 371(9631):2173-2182.
• [12]Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, Salem DN, Levey AS, Sarnak MJ: Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004, 15(5):1307-1315.
• [13]Chien KL, Hsu HC, Lee YT, Chen MF: Renal function and metabolic syndrome components on cardiovascular and all-cause mortality. Atherosclerosis 2008, 197(2):860-867.
• [14]Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR: High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 1977, 62(5):707-714.
• [15]Assmann G, Cullen P, Schulte H: Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Munster (PROCAM) study. Circulation 2002, 105(3):310-315.
• [16]Sachdeva A, Cannon CP, Deedwania PC, Labresh KA, Smith SC Jr, Dai D, Hernandez A, Fonarow GC: Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136, 905 hospitalizations in Get With The Guidelines. Am Heart J 2009, 157(1):111-117. e112
• [17]Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, et al.: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004, 364(9438):937-952.
• [18]Alsheikh-Ali AA, Lin JL, Abourjaily P, Ahearn D, Kuvin JT, Karas RH: Prevalence of low high-density lipoprotein cholesterol in patients with documented coronary heart disease or risk equivalent and controlled low-density lipoprotein cholesterol. Am J Cardiol 2007, 100(10):1499-1501.
• [19]Sarwar N, Danesh J, Eiriksdottir G, Sigurdsson G, Wareham N, Bingham S, Boekholdt SM, Khaw KT, Gudnason V: Triglycerides and the risk of coronary heart disease: 10, 158 incident cases among 262, 525 participants in 29 Western prospective studies. Circulation 2007, 115(4):450-458.
• [20]Bansal S, Buring JE, Rifai N, Mora S, Sacks FM, Ridker PM: Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. JAMA 2007, 298(3):309-316.
• [21]Nordestgaard BG, Benn M, Schnohr P, Tybjaerg-Hansen A: Nonfasting triglycerides and risk of myocardial infarction, ischemic heart disease, and death in men and women. JAMA 2007, 298(3):299-308.
• [22]Assmann G, Schulte H: Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience). Prospective Cardiovascular Munster study. Am J Cardiol 1992, 70(7):733-737.
• [23]Weverling-Rijnsburger AW, Jonkers IJ, van Exel E, Gussekloo J, Westendorp RG: High-density vs low-density lipoprotein cholesterol as the risk factor for coronary artery disease and stroke in old age. Arch Intern Med 2003, 163(13):1549-1554.
• [24]Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy CP, Younessi H, Anker SD, Morley JE: Risk factor paradox in wasting diseases. Current Opinion in Clinical Nutrition & Metabolic Care 2007, 10(4):433-442. 410.1097/MCO.1090b1013e3281a30594
• [25]Lavie CJ, Mehra MR, Milani RV: Obesity and heart failure prognosis: paradox or reverse epidemiology? European Heart Journal 2005, 26(1):5-7.
• [26]Speakman JR, Westerterp KR: Reverse Epidemiology, Obesity and Mortality in Chronic Kidney Disease: Modelling Mortality Expectations Using Energetics. Blood Purification 2010, 29(2):150-157.
• [27]Beddhu S: The Body Mass Index Paradox and an Obesity, Inflammation, and Atherosclerosis Syndrome in Chronic Kidney Disease. Seminars in Dialysis 2004, 17(3):229-232.
• [28]Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D: Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 1999, 56(6):2214-2219.
• [29]Fried LF, Shlipak MG, Crump C, Bleyer AJ, Gottdiener JS, Kronmal RA, Kuller LH, Newman AB: Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals. J Am Coll Cardiol 2003, 41(8):1364-1372.
• [30]Garg AX, Clark WF, Haynes RB, House AA: Moderate renal insufficiency and the risk of cardiovascular mortality: results from the NHANES I. Kidney Int 2002, 61(4):1486-1494.
• [31]Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004, 351(13):1296-1305.
• [32]Carter AM, Catto AJ, Mansfield MW, Bamford JM, Grant PJ: Predictive Variables for Mortality After Acute Ischemic Stroke. Stroke 2007, 38(6):1873-1880.
• [33]Fruchart JC, Sacks FM, Hermans MP, Assmann G, Brown WV, Ceska R, Chapman MJ, Dodson PM, Fioretto P, Ginsberg HN, et al.: The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patient. Diab Vasc Dis Res 2008, 5(4):319-335.
• [34]Chien KL, Hsu HC, Su TC, Lee YT: Consistency in genetic inheritance mode and heritability patterns of triglyceride vs. high density lipoprotein cholesterol ratio in two Taiwanese family samples. BMC Journal, Genetics 2003, 4:7-16.
• [35]Lopes-Virella M, Stone P, Ellis S, Colwell JA: Cholesterol determination in high-density lipoproteins separated by three different methods. ClinChem 1977, 23(5):882-884.
• [36]Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999, 130(6):461-470.
• [37]Hosmer DW Jr, Lemeshow S: The multiple logistic regression model. In Applied logistic regression. 1st edition. New York: John Wiley & Sons; 1989:25-37.
• [38]Hosmer DW, Lemeshow S: Applied survival analysis: regression modeling of time to event data. New York: Wiley; 1999.
• [39]Durrleman S, Simon R: Flexible regression models with cubic splines. Stat Med 1989, 8(5):551-561.