HDL Cholesterol Efflux Does Not Predict Cardiovascular Risk in Hemodialysis Patients
HDL Cholesterol Efflux Does Not Predict Cardiovascular Risk in Hemodialysis Patients
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DOI：
10.1681/asn.2016030262
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发表时间：
2017-03-01
影响因子：
13.6
通讯作者：
Tietge, Uwe J. F.
中科院分区：
文献类型：
--
作者：
Kopecky, Chantal;Ebtehaj, Sanam;Tietge, Uwe J. F.
高密度脂蛋白的心脏保护作用被认为在很大程度上取决于其胆固醇流出能力，在肾功能正常的人群中，这与动脉粥样硬化性心血管疾病呈负相关。终末期肾病患者心血管风险极高，传统危险因素无法完全解释。在这篇文章中，我们对参加德国糖尿病分析研究(4D研究)的1147名接受血液透析的2型糖尿病患者进行了事后分析，调查了高密度脂蛋白胆固醇流出能力是否可以预测心血管风险。外排能力通过人巨噬细胞泡沫细胞与apoB耗尽的血清孵育来定量。在中位数4.1年的随访中，423名患者达到合并的主要终点(包括心源性死亡、非致命性心肌梗死和中风)，410名患者发生心脏事件，561名患者死亡。值得注意的是，在COX回归分析中，我们发现外排能力与合并的主要终点(危险比[HR]，0.96；95%可信区间[95%CI]，0.88至1.06；P=0.42)、心脏事件(HR，0.92；95%CI，0.83至1.02；P=0.11)或全因死亡率(HR，0.96；95%CI，0.88至1.05；P=0.39)无关。总而言之，在这组接受血液透析的糖尿病患者中，高密度脂蛋白胆固醇流出能力不是预测心血管风险的指标。
The cardioprotective effect of HDL is thought to be largely determined by its cholesterol efflux capacity, which was shown to inversely correlate with atherosclerotic cardiovascular disease in populations with normal kidney function. Patients with ESRD suffer an exceptionally high cardiovascular risk not fully explained by traditional risk factors. Here, in a post hoc analysis in 1147 patients with type 2 diabetes mellitus on hemodialysis who participated in the German Diabetes Dialysis Study (4D Study), we investigated whether the HDL cholesterol efflux capacity is predictive for cardiovascular risk. Efflux capacity was quantified by incubating human macrophage foam cells with apoB-depleted serum. During a median follow-up of 4.1 years, 423 patients reached the combined primary end point (composite of cardiac death, nonfatal myocardial infarction, and stroke), 410 patients experienced cardiac events, and 561 patients died. Notably, in Cox regression analyses, we found no association of efflux capacity with the combined primary end point (hazard ratio [HR], 0.96; 95% confidence interval [95% CI], 0.88 to 1.06; P=0.42), cardiac events (HR, 0.92; 95% CI, 0.83 to 1.02; P=0.11), or all-cause mortality (HR, 0.96; 95% CI, 0.88 to 1.05; P=0.39). In conclusion, HDL cholesterol efflux capacity is not a prognostic cardiovascular risk marker in this cohort of patients with diabetes on hemodialysis.