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Atherosclerosis in hemodialysis patients: traditional and nontraditional risk factors
Sebastijan Bevc1, Radovan Hojs, Robert Ekart
1Clin. Dept. of Internal Medicine, Dept. of Nephrology, Maribor Teaching Hospital, Ljubljanska 5, 2000 Maribor, Slovenia.
Insights
In hemodialysis patients, advanced atherosclerosis is linked to traditional factors like age and cholesterol, and nontraditional factors, notably apolipoprotein B. These findings highlight key risk factors for cardiovascular disease in this population.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Biochemistry
Background:
- Patients undergoing hemodialysis exhibit a high prevalence of cardiovascular disease.
- Traditional risk factors for atherosclerosis may be insufficient to explain disease progression in hemodialysis patients.
Purpose of the Study:
- To investigate the association between traditional and nontraditional risk factors and asymptomatic atherosclerosis in hemodialysis patients.
- To identify specific biomarkers predictive of atherosclerosis in this cohort.
Main Methods:
- Ninety-one hemodialysis patients were assessed.
- Carotid artery intima-media thickness and plaque occurrence were measured using B-mode ultrasonography.
- Biochemical parameters, blood pressure, and smoking habits were evaluated.
Main Results:
- Intima-media thickness correlated with age, total cholesterol, LDL cholesterol, and apolipoprotein B.
- Patients with plaques were older and had significantly higher levels of total cholesterol, LDL cholesterol, triglycerides, and apolipoprotein B, with lower HDL cholesterol.
- Multivariate analysis confirmed associations between atherosclerosis markers (intima-media thickness, plaque occurrence/number) and age, and importantly, apolipoprotein B.
Conclusions:
- Hemodialysis patients demonstrate advanced atherosclerosis.
- Both traditional (e.g., age, lipid profile) and nontraditional risk factors (e.g., apolipoprotein B) are significantly associated with atherosclerosis in this population.
- Apolipoprotein B emerges as a key nontraditional risk factor linked to atherosclerosis severity in hemodialysis patients.
Aim:
To determine the significance of the relationship between some traditional risk factors (age, arterial hypertension, smoking, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides) and some nontraditional risk factors (lipoprotein[a], apolipoprotein A, apolipoprotein B, homocysteine, calcium, phosphorus, parathyroid hormone) and asymptomatic atherosclerosis in hemodialysis patients.
Methods:
Ninety-one hemodialysis patients were included in the study. Using B-mode ultrasonography, we measured intima-media thickness and plaque occurrence in the carotid arteries in these patients. Biochemical parameters were determined in all participants according to standard laboratory procedure, systolic and diastolic blood pressure was measured, and information on smoking habits was obtained by questionnaire.
Results:
A correlation between intima-media thickness and age of the hemodialysis patients was found. Intima-media thickness values also correlated with total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Compared to those without plaques, patients with plaques were statistically significantly older; had higher concentrations of total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B; and had lower concentrations of high-density lipoprotein cholesterol. The number of plaques correlated with age, total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B. Using multivariate models (linear or logistic regression) of traditional and nontraditional risk factors, a relationship was found between intima-media thickness, plaque occurrence, number of plaques, and age of the hemodialysis patients. With the same multivariate statistical analysis of nontraditional risk factors, a relationship was found only between intima-media thickness, plaque occurrence, number of plaques and apolipoprotein B.
Conclusion:
The results indicate that hemodialysis patients showed advanced atherosclerosis that is associated with traditional as well as nontraditional risk factors such as apolipoprotein B.
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