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Published on: June 16, 2014
Preheparin Serum Lipoprotein Lipase Mass as a Coronary Risk Factor in Patients With Chronic Kidney Disease
1Hitsumoto Medical Clinic, Shimonoseki City, Yamaguchi 750-0025, Japan.
Insights
Lower preheparin lipoprotein lipase mass (pre-LpL mass) predicts coronary artery disease (CAD) events in chronic kidney disease (CKD) patients. Increased advanced glycation end products and inflammation also indicate higher CAD risk in this population.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Biochemistry
Background:
- Lower preheparin lipoprotein lipase mass (pre-LpL mass) is associated with coronary artery disease (CAD).
- The predictive role of pre-LpL mass for CAD events in chronic kidney disease (CKD) patients is not well understood.
- This study investigates pre-LpL mass as a predictor of primary CAD events in CKD patients.
Purpose of the Study:
- To determine if preheparin lipoprotein lipase mass (pre-LpL mass) can predict primary coronary artery disease (CAD) events in patients with chronic kidney disease (CKD).
- To explore the relationship between pre-LpL mass, advanced glycation end products, inflammation, and CAD events in CKD patients.
Main Methods:
- Prospective study of 480 CKD outpatients without prior CAD.
- Patients categorized into low (n=211) and high (n=269) pre-LpL mass groups using ROC analysis.
- Follow-up for a median of 107 months to record primary CAD events.
Main Results:
- The low pre-LpL mass group had significantly higher baseline skin autofluorescence and hs-CRP.
- A higher incidence of CAD events occurred in the low pre-LpL mass group (14.7% vs. 4.1%, P < 0.001).
- Low pre-LpL mass was an independent predictor of primary CAD events (HR: 2.80; P = 0.003), alongside elevated advanced glycation end products and inflammation.
Conclusions:
- Reduced preheparin lipoprotein lipase mass (pre-LpL mass) is a significant predictor of primary coronary artery disease (CAD) events in patients with chronic kidney disease (CKD).
- Increased levels of advanced glycation end products and inflammation are also important contributing factors to CAD risk in CKD patients.
Background:
A significant association between lower preheparin serum lipoprotein lipase mass (pre-LpL mass) and coronary artery disease (CAD) has been reported in several clinical studies. However, the predictor of a pre-LpL mass as a CAD event in patients with chronic kidney disease (CKD) remains unclear. This prospective study aimed to investigate the clinical significance of a pre-LpL mass as a predictor of primary CAD events in patients with CKD.
Methods:
A total of 480 CKD patients who did not develop CAD among outpatients who visited the clinic were enrolled. Using receiver operating characteristic curve analysis for a primary CAD event, participants were divided into two groups (low pre-LpL mass (group L, n = 211) or high pre-LpL mass (group H, n = 269)) by pre-LpL mass, and significance of a pre-LpL mass as a predictor for the primary CAD events was performed.
Results:
At baseline, skin autofluorescence, an indicator of advanced glycation end products in vivo, and high-sensitivity C-reactive protein (hs-CRP) concentration, an indicator of inflammation, were significantly higher in group L than in group H. During the median observation period of 107 months, 42 patients experienced a CAD event (group L: n = 31 (14.7%) vs. group H: n = 11 (4.1%)). Group L had a significantly higher incidence of primary CAD events than group H (P < 0.001, log-rank test). Furthermore, patients in group L were at a significantly higher risk of developing a primary CAD event than those in group H based on the multivariate Cox regression analysis (hazard ratio: 2.80; 95% confidence interval, 1.39-5.64; P = 0.003). However, skin autofluorescence and hs-CRP were also significant factors for a primary CAD event.
Conclusions:
The prospective study showed that a decrease in pre-LpL mass is a useful predictor of a primary CAD event in patients with CKD. Additionally, background factors such as an increase in advanced glycation end products and inflammation are also an important factor in these patients.
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