Abstract 9258: LDL Phenotype-B is Strongly Associated With CHD Risk Among Individuals With CKD. The Multi-ethnic Study of Atherosclerosis (MESA)
Introduction: LDL phenotype B, characterized by high triglyceride (TG), small dense LDL (sd-LDL), and very low-density lipoprotein (VLDL) levels, and low high-density lipoprotein (HDL) levels, is the hallmark lipid phenotype of chronic kidney disease (CKD). Whether this phenotype is associated with clinical coronary heart disease (CHD) in individuals with CKD is not known.
Methods: CKD was defined as an eGFR of 15-59 ml/min/1.63m2 (stage 3-4). Principal component analyses were used to account for the correlations among lipoproteins defining lipid phenotype B. Nuclear magnetic resonance spectroscopy was used to measure lipoprotein sub-fractions. CHD was defined as a new MI, angina followed by revascularization, resuscitated cardiac arrest or CHD death.
Results: A total of 6,814 individuals free of CHD at baseline were followed for a median time of 8.5 years. CHD developed in 303 individuals (5%) with eGFR≥60 and in 72 individuals (12%) with CKD (p for difference<0.001). Principal component 1 captured the lipoprotein abnormalities defining lipid phenotype B: high TG levels (r for correlation with PC1=0.78), VLDL (r=0.73), sd-LDL(r=0.82) and low levels of HDL (r=-0.80). Compared to those without CKD, this phenotype (and its components) was more common (p for difference<0.001), and was more strongly associated with CHD in those with CKD (figure): adjusted hazard ratios and 95% confidence intervals 1.13 (1.00-1.28; p=0.05) and 1.51 (1.17-1.94; p=0.001) in eGFR≥60 and CKD respectively (p for interaction=0.04).
Conclusion: LDL phenotype-B is strongly associated with CHD risk in individuals with CKD. Whether a modification of the components of this phenotype leads to a reduction in the cardiovascular disease burden of individuals with CKD should be established in future studies.
- © 2013 by American Heart Association, Inc.