Association between LDL-C and Risk of Myocardial Infarction in CKD

Abstract

LDL cholesterol (LDL-C) is an important marker of coronary risk in the general population, but its utility in people with CKD is unclear. We studied 836,060 adults from the Alberta Kidney Disease Network with at least one measurement of fasting LDL-C, estimated GFR (eGFR), and proteinuria between 2002 and 2009. All participants were free of stage 5 CKD at cohort entry. We followed participants from first eGFR measurement to March 31, 2009; we used validated algorithms applied to administrative data to ascertain primary outcome (hospitalization for myocardial infarction) and Cox regression to calculate adjusted hazard ratios (HRs) for myocardial infarction by LDL-C categories within eGFR strata. During median follow-up of 48 months, 7762 patients were hospitalized for myocardial infarction, with incidence highest among participants with the lowest eGFR. Compared with 2.6-3.39 mmol/L (referent), the risk associated with having LDL-C above 4.9 mmol/L seemed greatest for GFR$90 ml/min per 1.73 m 2 and least for eGFR=15-59.9 ml/min per 1.73 m 2 . Specifically, the adjusted HRs (95% confidence intervals) of myocardial infarction associated with LDL-C of $4.9 compared with 2.6-3.39 mmol/L in participants with eGFR=15-59.9, 60-89.9, and $90 ml/min per 1.73 m 2 were 2.06 (1.59, 2.67), 2.30 (2.00, 2.65), and 3.01 (2.46, 3.69). In conclusion, the association between higher LDL-C and risk of myocardial infarction is weaker for people with lower baseline eGFR, despite higher absolute risk of myocardial infarction. Increased LDL-C may be less useful as a marker of coronary risk among people with CKD than the general population.

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

“…114 Statins reduce the risk of coronary events in people with non-dialysis-dependent CKD, but there is no evidence that they are beneficial in the presence of ESRD. [115][116][117] Because low-density lipoprotein cholesterol levels are poorly correlated with the risk of adverse clinical outcomes in CKD patients, 118 overall cardiovascular risk, not the serum lipid profile, is now the primary basis for prescribing statins in this population. 119 International guidelines recommend that statins be prescribed to all patients with non-dialysis-dependent CKD who are ≥50 years of age and to patients whose estimated 10-year risk of cardiovascular events exceeds 10%.…”

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

“…While LDL cholesterol is an established risk factor for CVD in the general population, its prognostic value appears to be less in those with CKD due to DKD or other causes (31). The magnitude of reduction in cholesterol levels in the CKD population (including those who are dialysis-treated) with statin therapy is similar to that in those with preserved kidney function (32).…”

Triglyceride to high-density lipoprotein cholesterol ratio predicts cardiovascular events in maintenance hemodialysis patients

“…Low-density lipoprotein cholesterol (LDL-C) has been found to be a non-sensitive marker for risk of CV events because of its weak association with coronary events in CKD patients who have a low estimated glomerular filtration rate [13,14], and no CV benefit in HD patients has been clearly demonstrated in response to aggressive LDL-C reduction strategies [15,16]. Hypertriglyceridemia has been reported to have a U-shaped relationship with mortality in HD patients [17,18], whereas HDL-C has been reported to have a discordant association with allcause or CV mortality in HD patients [19,20].…”