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Updated: May 24, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
ApoM and Major Adverse Cardiovascular Events in Chronic Kidney Disease: A Prospective Cohort Study
Julia T Stadler1,2, Andrea Borenich3, Line Stattau Bisgaard4,5
1Division of Pharmacology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation (J.T.S., G.M.), Medical University of Graz, Austria.
Insights
Low levels of APOM protein are linked to a higher risk of major adverse cardiovascular events and death in chronic kidney disease (CKD) patients. APOM may offer cardiovascular protection in this high-risk group.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Cardiovascular disease is the primary cause of death in chronic kidney disease (CKD) patients.
- APOM protein is crucial for reverse cholesterol transport and possesses antiatherogenic properties.
- Investigating APOM's role in CKD cardiovascular risk is essential.
Purpose of the Study:
- To examine the association between plasma APOM levels and adverse cardiovascular outcomes in CKD patients.
- To determine if APOM levels predict major adverse cardiovascular events (MACE) and all-cause mortality in this population.
Main Methods:
- Quantification of plasma APOM and S1P levels using ELISA and HPLC.
- Analysis of a composite endpoint of MACE and all-cause mortality in CKD patients.
- Secondary analysis of the CARE FOR HOMe study and validation in the Copenhagen CKD study.
Main Results:
- Lower plasma APOM levels were significantly associated with increased risk of MACE and all-cause mortality in CKD patients.
- The inverse association between APOM and MACE remained significant after adjusting for cardiovascular risk factors.
- Plasma S1P showed a non-significant association with MACE after multivariable adjustment.
Conclusions:
- Low plasma APOM levels are a significant predictor of MACE in patients with CKD.
- APOM may play a protective role against cardiovascular events in the CKD population.
- Further research into APOM as a therapeutic target for cardiovascular protection in CKD is warranted.
Background:
Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease (CKD). APOM plays a critical role in reverse cholesterol transport by facilitating the formation of pre-β-HDL (high-density lipoprotein) and enabling the binding of S1P (sphingosine-1-phosphate) to HDL, a complex involved in several antiatherogenic processes. In this study, we sought to investigate the potential association between plasma APOM levels and the risk of adverse cardiovascular outcomes in individuals with CKD.
Methods:
Plasma APOM levels were quantified using a sandwich ELISA-based assay. Plasma S1P levels were measured by high-performance liquid chromatography. The primary end point was a composite of major adverse cardiovascular events (MACE) and all-cause mortality.
Results:
In this secondary analysis of the CARE FOR HOMe study (Cardiovascular and Renal Outcome in CKD 2-4 Patients-The Fourth Homburg Evaluation), 463 nondialysis patients with CKD stages G2 to G4 were included. Plasma APOM levels exhibited a significant inverse association with the risk of MACE (standardized hazard ratio, 0.60 [95% CI, 0.49-0.75]; P<0.001) and all-cause mortality (standardized hazard ratio, 0.63 [95% CI, 0.48-0.83]; P<0.001). This inverse association with MACE remained robust after adjusting for established cardiovascular and renal risk factors. These findings were further corroborated in an independent cohort of 822 patients with CKD from the Copenhagen CKD study. Plasma S1P levels showed an inverse association with MACE in univariable analyses; however, this relationship lost statistical significance after multivariable adjustments.
Conclusions:
Our findings demonstrate a significant association between low plasma APOM levels and an increased risk of MACE in patients with CKD. These results suggest that APOM may play a role in cardiovascular protection in this vulnerable population.
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