HDL Cholesterol Is Not Associated with Lower Mortality in Patients with Kidney Dysfunction

Zewinger, Stephen; Speer, Thimoteus; Kleber, Marcus E.; Scharnagl, Hubert; Woitas, Rainer; Lepper, Philipp M.; Pfahler, Karolin; Seiler, Sarah; Heine, Gunnar H.; März, Winfried; Silbernagel, Günther; Fliser, Danilo (2014). HDL Cholesterol Is Not Associated with Lower Mortality in Patients with Kidney Dysfunction. Journal of the American Society of Nephrology, 25(5), pp. 1073-1082. Lippincott Williams & Wilkins 10.1681/ASN.2013050482

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In the general population, HDL cholesterol (HDL-C) is associated with reduced cardiovascular events. However, recent experimental data suggest that the vascular effects of HDL can be heterogeneous. We examined the association of HDL-C with all-cause and cardiovascular mortality in the Ludwigshafen Risk and Cardiovascular Health study comprising 3307 patients undergoing coronary angiography. Patients were followed for a median of 9.9 years. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. The effect of increasing HDL-C serum levels was assessed using Cox proportional hazard models. In participants with normal kidney function (eGFR>90 ml/min per 1.73 m(2)), higher HDL-C was associated with reduced risk of all-cause and cardiovascular mortality and coronary artery disease severity (hazard ratio [HR], 0.51, 95% confidence interval [95% CI], 0.26-0.92 [P=0.03]; HR, 0.30, 95% CI, 0.13-0.73 [P=0.01]). Conversely, in patients with mild (eGFR=60-89 ml/min per 1.73 m(2)) and more advanced reduced kidney function (eGFR<60 ml/min per 1.73 m(2)), higher HDL-C did not associate with lower risk for mortality (eGFR=60-89 ml/min per 1.73 m(2): HR, 0.68, 95% CI, 0.45-1.04 [P=0.07]; HR, 0.84, 95% CI, 0.50-1.40 [P=0.50]; eGFR<60 ml/min per 1.73 m(2): HR, 1.18, 95% CI, 0.60-1.81 [P=0.88]; HR, 0.82, 95% CI, 0.40-1.69 [P=0.60]). Moreover, Cox regression analyses revealed interaction between HDL-C and eGFR in predicting all-cause and cardiovascular mortality (P=0.04 and P=0.02, respectively). We confirmed a lack of association between higher HDL-C and lower mortality in an independent cohort of patients with definite CKD (P=0.63). In summary, higher HDL-C levels did not associate with reduced mortality risk and coronary artery disease severity in patients with reduced kidney function. Indeed, abnormal HDL function might confound the outcome of HDL-targeted therapies in these patients.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology
UniBE Contributor:	Silbernagel, Günther
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1046-6673
Publisher:	Lippincott Williams & Wilkins
Language:	English
Submitter:	Catherine Gut
Date Deposited:	13 Oct 2014 14:17
Last Modified:	05 Dec 2022 14:35
Publisher DOI:	10.1681/ASN.2013050482
PubMed ID:	24610925
URI:	https://boris.unibe.ch/id/eprint/54477