Inflammation Alters Relationship Between High-Density Lipoprotein Cholesterol and Cardiovascular Risk in Patients With Chronic Kidney Disease: Results From KNOW-CKD
- Authors
- Kim, Jae Young; Park, Jung Tak; Kim, Hyung Woo; Chang, Tae-Ik; Kang, Ea Wha; Ahn, Curie; Oh, Kook-Hwan; Lee, Joongyub; Chung, Wookyung; Kim, Yong-Soo; Kim, Soo Wan; Yoo, Tae-Hyun; Kang, Shin-Wook; Han, Seung Hyeok
- Issue Date
- 17-Aug-2021
- Publisher
- WILEY
- Keywords
- chronic kidney disease; high-density lipoprotein cholesterol; high-sensitivity C-reactive protein; inflammation; major adverse cardiovascular events
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.10, no.16
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 10
- Number
- 16
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/81929
- DOI
- 10.1161/JAHA.120.021731
- ISSN
- 2047-9980
- Abstract
- 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.
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