Nonesterified Fatty Acids and Cardiovascular Mortality in Elderly Men with CKD

Abstract

Background and objectives Although nonesterified fatty acids (NEFAs) are essential as energy substrate for the myocardium, an excess of circulating NEFAs can be harmful. This study aimed to assess plausible relationships between serum NEFA and mortality due to cardiovascular disease (CVD) in individuals with CKD.Design, setting, participants, & measurements This was a prospective cohort study from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of 1221 elderly men aged 70-71 years residing in Uppsala, Sweden. Data collection took place during 1991-1995. All participants had measures of kidney function; this study investigated 623 (51.7%) of these patients with manifest CKD (defined as either eGFR,60 ml/min per 1.73 m 2 or urine albumin excretion rate $20 mg/min). Follow-up for mortality was done from examination date until death or December 31, 2007. After a median follow-up of 14 years (interquartile range, 8-16.8), associations of NEFAs with mortality (related to all causes, CVD, ischemic heart disease [IHD], or acute myocardial infarction) were ascertained.Results The median serum NEFA was 14.1 mg/dl (interquartile range, 11.3-17.8). No association was found with measures of kidney function. Diabetes and serum triglycerides were the only multivariate correlates of NEFA. During follow-up, 453 participants died, of which 209 deaths were due to CVD, including 88 IHD deaths, with 41 attributed to acute myocardial infarction (AMI). In fully adjusted covariates, serum NEFA was an independent risk factor for all-cause mortality (hazard ratio [HR] per log 2 increase, 1.22; 95% confidence interval [95% CI], 1.00 to 1.48) and CVD-related death (HR, 1.51; 95% CI, 1.15 to 1.99), including both IHD (HR, 1.51; 95% CI, 1.00 to 2.32) and AMI mortality (HR, 2.08; 95% CI, 1.09 to 3.98).Conclusions Elevated serum NEFA associated with CVD mortality, and particularly with mortality due to AMI, in a homogeneous population of older men with moderate CKD.

Altered Protein Composition of Subcutaneous Adipose Tissue in Chronic Kidney Disease

“… 16 , 17 , 18 , 19 , 20 , 21 The supporting data include the observation that CKD patients have elevated NEFA concentrations, an independent predictor of all-cause and cardiovascular death. 21 Furthermore, CKD patients have perturbed circulating adipokine concentrations 18 , 20 and increased systemic inflammation that correlates with fat mass. 16 Indeed, visceral fat mass in peritoneal dialysis patients is an independent predictor of vessel dysfunction and therefore a risk factor for CVD.…”

A high serum-free fatty acid level is associated with cancer

“…Free fatty acids (FFAs) are intermediate products of lipid mobilization that result principally from lipolysis and the breakdown of triglycerides (TGs) (Stich and Berlan 2004). Previous studies have reported that FFA levels are associated with unfavorable functional outcomes in stroke and cardiovascular disease and may play a role in the process of disease progression (Choi et al 2014;Sun et al 2015;Xiong et al 2015;Duan et al 2017;Han et al 2018). In clinical work, we found that in some cancer patients, the FFA level was elevated even when TGs and total cholesterol (TCHO) were normal, and a high FFA level may be the only abnormality in biochemical tests.…”

Impact of Blood or Erythrocyte Membrane Fatty Acids for Disease Risk Prediction: Focusing on Cardiovascular Disease and Chronic Kidney Disease

“…Free FA accumulation is associated with CVD risk and mortality. In a prospective cohort study including 1221 elderly men in Sweden, increased free FA levels are associated with the risk for cardiovascular mortality in patients with CKD [ 98 ]. Even in patients who underwent kidney transplantation, CVD is still a major cause of post-transplantation mortality.…”