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Lp(a) and premature mortality during chronic hemodialysis treatment
M D Cressman1, D Abood, J O'Neil
1Department of Cardiovascular Biology, Cleveland Clinic Foundation, Ohio 44195.
Insights
Elevated Lipoprotein(a) predicts fatal cardiovascular events in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). This finding highlights Lp(a) as a critical risk factor for cardiovascular disease (CVD) mortality in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Patients with end-stage renal disease (ESRD) exhibit significantly higher Lipoprotein(a) [Lp(a)] levels compared to individuals with normal kidney function.
- Hypertriglyceridemia affects about 50% of ESRD patients on chronic hemodialysis (HD), correlating with increased cardiovascular disease (CVD) prevalence.
Purpose of the Study:
- To analyze cardiovascular disease (CVD) risk in hemodialysis (HD) patients with and without pre-existing ischemic CVD or severe atherosclerotic lesions.
- To determine the predictive value of Lipoprotein(a) [Lp(a)] levels for fatal and non-fatal cardiovascular events during maintenance HD.
Main Methods:
- Prospective study analyzing 129 end-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD).
- Detailed analysis of baseline lipid profiles (Total Cholesterol, Triglycerides, apoprotein B) and Lipoprotein(a) [Lp(a)] levels.
- Comparison of outcomes between patients with and without pre-existing cardiovascular disease (CVD) and assessment of predictors for fatal CVD events over 48 months.
Main Results:
- Patients with prevalent CVD had higher baseline Total Cholesterol (TC), Triglyceride (TG), and apoprotein B (apoB) levels.
- Serum TG levels did not differ between survivors and those experiencing fatal CVD events.
- Lipoprotein(a) [Lp(a)] levels were similar in patients with or without pre-existing CVD, but Lp(a) independently predicted fatal cardiovascular disease (CVD) events.
Conclusions:
- Lipoprotein(a) [Lp(a)] is a significant independent predictor of fatal cardiovascular events in end-stage renal disease (ESRD) patients on hemodialysis (HD).
- Despite similar baseline Lp(a) levels, elevated Lp(a) identifies a higher risk for CVD mortality in this patient group.
Abstract:
Lipoprotein(a) levels are approximately three to four times higher in patients with end-stage renal disease (ESRD) when compared to controls with normal renal function (H.J. Parra, H. Mezdour, C. Cachera et al., Clin. Chem. 33 (1987), 721). Hypertriglyceridemia occurs in approximately 50% of ESRD patients receiving chronic hemodialysis (HD) treatment and has been associated with an increased prevalence of cardiovascular disease (CVD) in cross-sectional studies of this subset of ESRD patients. We recently reported that HD patients with pre-existing ischemic or atherosclerotic CVD and patients with elevated Lp(a) levels had an increased risk of fatal and non-fatal clinical events attributable to CVD during a 48-month period of maintenance HD treatment. The current report describes a detailed analysis of study participants who did or did not have a history of ischemic CVD or angiographically documented severe atherosclerotic lesions prior to entry into our prospective study. Although baseline total cholesterol (TC), triglyceride (TG) and apoprotein B (apoB) levels were higher in the 36 participants with prevalent CVD than the remaining 93 study participants, total cholesterol levels were somewhat lower, while serum triglyceride levels were no different in patients who survived or experienced fatal CVD events during the period of observation on HD treatment. In contrast, Lp(a) levels were no different in participants with or without evidence of pre-existing CVD. Lp(a) was, however, an independent predictor of fatal events attributable to cardiovascular disease during the period of follow-up.