Inflammation Alters Relationship Between High-Density Lipoprotein Cholesterol and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From KNOW-CKD.
Background The function of high-density lipoprotein can change from protective to proatherosclerotic under inflammatory conditions. Herein, we studied whether inflammation could modify the relationship between high-density lipoprotein level and risk of adverse outcomes in patients with chronic kidney disease . Methods and Results In total, 1864 patients from the prospective KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) were enrolled. The main predictor was high-density lipoprotein cholesterol (HDL-C) level. Presence of inflammation was defined by hs-CRP (high-sensitivity C-reactive protein) level of ≥1.0 mg/L. The primary outcome was extended major adverse cardiovascular events. During 9231.2 person-years of follow-up, overall incidence of the primary outcome was 15.8 per 1000 person-years. In multivariable Cox analysis after adjusting for confounders, HDL-C level was not associated with the primary outcome. There was a significant interaction between the inflammatory status and HDL-C for risk of extended major adverse cardiovascular events (P=0.003). In patients without inflammation, the hazard ratios (HRs) (95% CIs) for HDL-C levels <40, 50 to 59, and ≥60 mg/dL were 1.10 (0.50-1.82), 0.95 (0.50-1.82), and 0.42 (0.19-0.95), respectively, compared with HDL-C of 40 to 49 mg/dL. However, the significant association for HDL-C ≥60 mg/dL was not seen after Bonferroni correction. In patients with inflammation, we observed a trend toward increased risk of extended major adverse cardiovascular events in higher HDL-C groups (HRs [95% CIs], 0.73 [0.37-1.43], 1.24 [0.59-2.61], and 1.56 [0.71-3.45], respectively), but without statistical significance. Conclusions The association between HDL-C level and adverse cardiovascular outcomes showed reverse trends based on inflammation status in Korean patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.
['Kim|Jae Young|JY|', 'Park|Jung Tak|JT|', 'Kim|Hyung Woo|HW|', 'Chang|Tae-Ik|TI|', 'Kang|Ea Wha|EW|', 'Ahn|Curie|C|', 'Oh|Kook-Hwan|KH|', 'Lee|Joongyub|J|', 'Chung|Wookyung|W|', 'Kim|Yong-Soo|YS|', 'Kim|Soo Wan|SW|', 'Yoo|Tae-Hyun|TH|', 'Kang|Shin-Wook|SW|', 'Han|Seung Hyeok|SH|', '|||']
D000328:Adult D000368:Aged D015415:Biomarkers D002097:C-Reactive Protein D002318:Cardiovascular Diseases D008076:Cholesterol, HDL D005260:Female D000082742:Heart Disease Risk Factors D006801:Humans D015994:Incidence D007249:Inflammation D018836:Inflammation Mediators D008297:Male D008875:Middle Aged D011446:Prospective Studies D051436:Renal Insufficiency, Chronic D056910:Republic of Korea D018570:Risk Assessment D055815:Young Adult
inflammation chronic kidney disease major adverse cardiovascular events high‐density lipoprotein cholesterol high‐sensitivity C‐reactive protein