Oxidized LDL, statin use, morbidity, and mortality in patients receiving maintenance hemodialysis.
Statin treatment reduces the risk of cardiovascular mortality in the general population, but it has little or no benefit in hemodialyzed (HD) patients. This may reflect different underlying pathophysiology of cardiovascular disease (CVD) in patients treated with HD, maybe involving the oxidative stress. Our aim was to assess the association of oxidized low-density lipoprotein (oxLDL), determined by Mercodia oxLDL enzyme-linked immunosorbent assay (ELISA) kit, with major adverse cardiac events (MACE) and all-cause mortality in HD patients based on the AURORA trial (rosuvastatin vs placebo), and patients not on HD from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We also assessed whether its decrease due to statin use improves these outcomes using Cox proportional hazard models. Baseline oxLDL level was 34.2 ± 13.8 U/L in AURORA and did not differ between treatment groups, and 74.6 ± 28.1 U/L in LURIC. Lower baseline oxLDL levels were associated with higher hazard ratios (HRs) for outcomes, but not anymore after adjusting for apolipoprotein B level in AURORA and was not related to mortality in LURIC. OxLDL levels decreased by 30.9% between baseline and 3 months in the statin-treated group and increased by 10.5% between 3 and 12 months. Nevertheless, oxLDL reduction was not significantly associated with adjusted HRs for MACE and for all-cause mortality. These results showed no association between oxLDL and MACE after adjustment on apolipoprotein B, which may relate to the properties of the method used for oxLDL. Our results also showed no benefit for oxLDL reduction by rosuvastatin on outcomes. Future clinical trials are needed to define the relative CVD risks and benefits of other modalities of oxidative stress modification in this population.
['Wagner|Sandra|S|', 'Apetrii|Mugurel|M|', 'Massy|Ziad A|ZA|', 'Kleber|Marcus E|ME|', 'Delgado|Graciela E|GE|', 'Scharnagel|Hubert|H|', 'März|Winfried|W|', 'Metzger|Marie|M|', 'Rossignol|Patrick|P|', 'Jardine|Alan|A|', 'Holdaas|Hallvard|H|', 'Fellström|Bengt|B|', 'Schmieder|Roland|R|', 'Stengel|Bénédicte|B|', 'Zannad|Faiez|F|', '|||']
D000368:Aged D015415:Biomarkers D002318:Cardiovascular Diseases D003131:Combined Modality Therapy D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D007676:Kidney Failure, Chronic D008077:Lipoproteins, LDL D008875:Middle Aged D018384:Oxidative Stress D016016:Proportional Hazards Models D006435:Renal Dialysis D000068718:Rosuvastatin Calcium
Oxidized LDL statin mortality cardiovascular risks hemodialyzed patients