Physicians' Academy for Cardiovascular Education

Lipid-related residual risk and renal function for occurence of ACS

Literature - Kuo-Liong Chien et al, Lipids in Health and Disease 2011,10:215

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

Kuo-Liong Chien, Hung-Ju Lin, Hsiu-Ching Hsu and Ming-Fong Chen

Lipids in Health and Disease 2011,10:215

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.

Background

Since LDL-C can be aggressively lowered with statins, residual risk related to lipids, including low HDL-C and high TG, has become more important [1-4].
Individuals with low HDL-C and high triglycerides are at about 70% higher relative risk compared with those without [5,6]. For the prevention of coronary events, residual risk, including lipid-related, is an important factor to consider [7,8].
Furthermore, there is evidence that poor renal function is associated with cardiovascular diseases [9,10]. Previous studies did not investigate renal function concurrently with the role of lipid residual risk.
This case-control study investigated associations between lipid-related residual risk and renal function with acute coronary syndrome and prognostics factors for post-event survival in Taiwanese patients.


Results

The study included 557 patients and 1086 matched control subjects. Subjects in the higher quintiles of HDL-C had lower odds for acute coronary events. With respect to glomerular filtration rates, the highest filtration rate quintile was significantly associated with odds for acute coronary syndrome events after multiple adjustments for clinical covariates.
HDL-C was inversely associated with an ACS event, although HDL-C was not related to post-event mortality (figure 1). There was, however, no relationship between high triglycerides and the occurrence of a coronary event, but triglycerides were inversely related to post-event mortality (figure 2).
Glomerular filtration rate was also not associated with coronary events, but a high filtration rate was a protective factor for post-event mortality (figure 3).

Conclusion

Whereas low HDL-C was significantly associated with acute coronary events, both triglyceride levels and renal function were inversely related to all-cause post-event mortality. Further studies on the relationship between lipids, renal function and coronary events are necessary.
Relationship between HDL-C concentrations and the risk of acute coronary syndrome event (left) and all-cause mortality after event (right). The multivariate adjusted relative risks were plotted as a function of the baseline HDL-C value with the 95% confidence bands shown as the shaded area

Relationship between triglyceride concentrations and the risk of acute coronary syndrome event (left) and all-cause mortality after event (right). The multivariate adjusted relative risks were plotted as a function of the baseline triglyceride value with the 95% confidence bands shown as the shaded area.

Relationship between glomerular filtration rates and the risk of acute coronary syndrome event (left) and all-cause mortality after event (right). The multivariate adjusted relative risks were plotted as a function of the baseline glomerular filtration rate with the 95% confidence bands shown as the shaded area.

References

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4. Standards of medical care in diabetes–2008. Diabetes Care 2008, 31(Suppl 1):S12-54.
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6. Kearney PM, et al: 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. Carey VJ, et al: 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.
8. Fruchart JC, et al: 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.
9. Weiner DE, et al: 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.
10. Chien KL, et al: Renal function and metabolic syndrome components on cardiovascular and all-cause mortality. Atherosclerosis 2008, 197(2):860-867.

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