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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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High cholesterol absorption is associated with increased cardiovascular risk in haemodialysis patients: insights from

Günther Silbernagel1, Kévin Duarte2, Samir Sadiku3

  • 1Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.

European Journal of Preventive Cardiology
|May 5, 2022
PubMed

Insights

Statin treatment did not prevent cardiovascular events in hemodialysis patients. High cholesterol absorption increases cardiovascular risk, but statin therapy does not benefit patients with high cholesterol absorption.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Pharmacology

Background:

  • Cardiovascular disease (CVD) is a leading cause of mortality in patients undergoing hemodialysis.
  • Previous studies suggested statin therapy might reduce CVD risk in this population, but results have been inconsistent.
  • Cholesterol metabolism, including absorption and synthesis, plays a role in CVD pathogenesis.

Purpose of the Study:

  • To investigate the association between cholesterol absorption and synthesis rates and cardiovascular event risk in hemodialysis patients.
  • To determine if cholesterol metabolism markers predict response to statin therapy in this population.

Main Methods:

  • The AURORA trial was a randomized, double-blind, placebo-controlled study involving hemodialysis patients.
  • Participants received rosuvastatin or placebo, with follow-up for cardiovascular death.
  • Cholesterol absorption and synthesis were estimated using cholestanol and lathosterol to cholesterol ratios, respectively.

Main Results:

  • High cholesterol absorption, indicated by higher cholestanol to cholesterol ratio, was significantly associated with increased cardiovascular death risk.
  • High cholesterol synthesis, indicated by higher lathosterol to cholesterol ratio, was significantly associated with decreased cardiovascular death risk.
  • No significant interaction was found between cholesterol metabolism markers and statin treatment in predicting cardiovascular death.

Conclusions:

  • High cholesterol absorption is linked to elevated cardiovascular risk in hemodialysis patients.
  • The findings do not support using cholesterol absorption rates to guide statin initiation in this patient group.
Abstract

Keywords:
Cardiovascular riskCholestanolCholesterolCholesterol absorptionHemodialysisRandomized controlled trialRosuvastatin

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