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Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease

Gabriel Contreras1, Bo Hu, Brad C Astor

  • 1Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 360E, Miami, FL 33136, USA. gcontrer@med.miami.edu

Journal of the American Society of Nephrology : JASN
|September 25, 2010
PubMed

Insights

Malnutrition or inflammation (M-I) alters the link between cholesterol and cardiovascular disease (CVD) risk in African Americans with hypertensive chronic kidney disease (CKD). The cholesterol-CVD relationship was stronger in those without M-I.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Cardiovascular disease (CVD) is a leading cause of mortality in patients with chronic kidney disease (CKD).
  • The association between cholesterol levels and CVD risk is often attenuated in moderate to severe CKD.
  • Malnutrition-inflammation (M-I) syndrome is common in CKD and may influence CVD risk.

Purpose of the Study:

  • To investigate whether M-I modifies the relationship between cholesterol levels and CVD events in African Americans with hypertensive CKD.

Main Methods:

  • A cohort of 990 African American participants with hypertensive CKD (GFR 20-65 ml/min/1.73 m²) was stratified based on the presence or absence of M-I.
  • M-I was defined by body mass index <23 kg/m² or C-reactive protein >10 mg/L at baseline.
  • The primary composite outcome included cardiovascular death or hospitalization for coronary artery disease, stroke, or congestive heart failure over a median follow-up of 77 months.

Main Results:

  • Baseline total cholesterol and CVD outcome incidence were similar between participants with and without M-I.
  • Adjusted analyses revealed a significantly stronger relationship between total cholesterol and the CVD composite outcome in participants without M-I compared to those with M-I (P < 0.02).
  • In the non-M-I group, hazard ratios for CVD increased with higher cholesterol levels, whereas in the M-I group, HRs did not significantly vary by cholesterol level.

Conclusions:

  • The presence of malnutrition or inflammation (M-I) modifies the risk relationship between cholesterol levels and cardiovascular disease (CVD) in African Americans with hypertensive chronic kidney disease (CKD).
  • These findings highlight the complex interplay between M-I, cholesterol, and CVD risk in this specific patient population.

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