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Associations Between Low-Density Lipoprotein Cholesterol Levels and Cardiovascular Outcomes in Patients Undergoing
Byung Sik Kim1, Jiyeong Kim2,3, Nayeon Choi2
1Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 11923, Republic of Korea.
Insights
Elevated low-density lipoprotein cholesterol (LDL-C) significantly increases cardiovascular risk in dialysis patients. Managing LDL-C is crucial for this high-risk group to prevent adverse outcomes like heart attack and stroke.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Low-density lipoprotein cholesterol (LDL-C) is a known risk factor for atherosclerosis and cardiovascular disease (CVD).
- The role of LDL-C in cardiovascular outcomes for patients on dialysis is debated, with current guidelines often discouraging statin use.
- This study examines the link between LDL-C levels and CVD events in Korean adults undergoing dialysis.
Purpose of the Study:
- To investigate the association between LDL-C levels and cardiovascular outcomes in patients undergoing dialysis.
- To determine if elevated LDL-C poses a significant risk for adverse cardiovascular events in this population.
- To inform potential management strategies for lipid levels in end-stage kidney disease patients.
Main Methods:
- Utilized nationwide data from the Korean National Health Insurance Service (2009-2017).
- Included 21,692 patients with end-stage kidney disease on dialysis, divided into statin non-users and users.
- Analyzed cardiovascular outcomes, including composite events of cardiovascular death, myocardial infarction, and ischemic stroke, based on categorized LDL-C levels.
Main Results:
- In statin non-users, LDL-C levels above 100 mg/dL showed a dose-dependent increase in the risk of composite cardiovascular outcomes compared to levels below 70 mg/dL.
- Patients with LDL-C ≥ 160 mg/dL had a 43% higher risk of composite outcomes and a 2.25-fold higher risk of myocardial infarction.
- Among statin users, LDL-C levels exceeding 130 mg/dL were linked to an increased risk of composite cardiovascular outcomes.
Conclusions:
- Elevated LDL-C is significantly associated with adverse cardiovascular outcomes in patients undergoing dialysis.
- Close monitoring and proactive management of LDL-C levels are essential for this high-risk population.
- Further research is needed to develop targeted lipid-lowering therapies to improve cardiovascular health in dialysis patients.
Abstract:
Background/Objectives: Low-density lipoprotein cholesterol (LDL-C) is a causal factor in the development of atherosclerosis and a predictor of cardiovascular disease. However, the association between LDL-C levels and cardiovascular outcomes in patients undergoing dialysis remains controversial, with current guidelines advising against initiating statin therapy in this population. This study investigated the relationship between LDL-C levels and cardiovascular outcomes in Korean adults undergoing dialysis, using nationwide data. Methods: A total of 21,692 patients with end-stage kidney disease undergoing dialysis between 2009 and 2017 were identified from the Korean National Health Insurance Service database. Statin non-users (primary cohort) and users (secondary cohort) comprised 15,414 and 6278 patients, respectively. LDL-C levels were categorized, and cardiovascular outcomes including composites of cardiovascular death, myocardial infarction, and ischemic stroke were analyzed. Results: Among statin non-users, LDL-C levels > 100 mg/dL were significantly associated with an increased risk of the composite outcome, in a dose-dependent manner, compared with LDL-C levels < 70 mg/dL. Specifically, participants with LDL-C levels ≥ 160 mg/dL demonstrated a 43% increased risk of the composite outcome and a 2.25-fold higher risk of myocardial infarction compared to those with LDL-C levels < 70 mg/dL. Among statin users, LDL-C levels > 130 mg/dL were associated with an increased risk of the composite outcome. Conclusions: This study highlights the significant association between elevated LDL-C levels and adverse cardiovascular outcomes in patients undergoing dialysis. These findings underscore the importance of close monitoring and proactive management of LDL-C levels in this high-risk population. Future research should focus on developing tailored lipid-lowering strategies to improve cardiovascular outcomes in these patients.
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