Abstract 9322: Remnant Lipoproteinemia is a Predictor of Coronary Events in Patients with Coronary Artery Disease and Chronic Kidney Disease
Although triglyceride (TG) levels are increased in chronic kidney disease (CKD), the independence of high TG levels as a risk for coronary events remains debatable. We have previously shown that remnant lipoproteins, one of TG-rich lipoproteins, is a strong risk for future coronary events independent of low HDL-C levels and high LDL-C levels in patients with coronary artery disease (CAD). Thus, this study examined predictive value of remnant lipoproteins for coronary events in CAD patients with CKD.
Methods: Fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method in 229 patients with CAD and CKD (estimated GFR < 60 ml/min/1.73m2, excluding hemodialysis patients). All patients were prospectively followed up for a period of 18 months or until occurrence of one of following events: cardiac death, nonfatal myocardial infarction (MI), unstable angina requiring unplanned coronary revascularization or worsening heart failure requiring hospitalization.
Results: During follow-up period, events occurred in 28 (37%) patients with higher levels of RLP-C (> 5.0 mg/dL, 75th percentile of the distribution) (5 cardiac death, 4 MI, 15 unstable angina, 4 heart failure), while events occurred in 18 (11.7%) patients with lower RLP-C levels (< 5.0 mg/dL) (2 MI, 14 unstable angina, 2 heart failure) (p<0.0001). In Kaplan-Meier analysis, higher RLP-C levels resulted in a higher probability for the development of coronary events than lower RLP-C levels (p < 0.01). In multivariate Cox proportional hazards analysis, higher RLP-C levels were a significant predictor of coronary events (HR 1.8, 95%CI 1.3 - 6.9, p < 0.01), that was independent of TG levels and the Framingham risk variables. In c-statistics, RLP-C levels had an incremental effect on the predictive value of the Framingham risk variables for coronary events (area under ROC curve: RLP-C + Framingham risks 0.83 vs. Framingham risks alone 0.75, p < 0.01).
Conclusions: High remnant lipoprotein levels are an independent predictor of coronary events in CAD patients with CKD. Assessment of remnant lipoprotein levels may be useful for risk stratification for coronary events in patients with CKD.
- © 2011 by American Heart Association, Inc.