Associations among apolipoproteins, oxidized high-density lipoprotein and cardiovascular events in patients on hemodialysisReportar como inadecuado




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Apolipoproteins are associated with survival among patients on hemodialysis HD, but these associations might be influenced by dysfunctional oxidized high-density lipoprotein HDL. We assessed associations among apolipoproteins and oxidized HDL, mortality and cardiovascular disease CVD events in patients on HD. This prospective observational study examined 412 patients on prevalent HD. Blood samples were obtained before dialysis at baseline to measure lipids, apolipoproteins, oxidized LDL, oxidized HDL, high-sensitivity C-reactive protein hs-CRP and interleukin IL-6 at baseline, and HDL-C and hs-CRP were measured 12 months later. Patients were then prospectively followed-up mean, 40 months and all-cause mortality and composite CVD events were analyzed. Associations between variables at baseline and clinical outcome were assessed by Cox proportional hazards modeling n = 412 and Cox hazards modeling with a time-varying covariate with HDL-C and hs-CRP n = 369. Quartiles of apolipoproteins and oxidized HDL were not associated with all-cause mortality. However, Cox proportional hazards models with quartiles of each variable adjusted for confounders and hs-CRP or IL-6 identified apolipoprotein apoB-to-apoA-I ratio apoB-apoA-I and oxidized HDL, but not apoA-I or apoA-II, as independent risk factors for composite CVD events. These associations were confirmed by Cox proportional hazards modeling with time-varying covariates for hs-CRP. ApoB-apoA-I was independently associated with composite CVD events in 1-standard deviation SD increase-of-variables models adjusted for the confounders, oxidized HDL and hs-CRP. However, these associations disappeared from the model adjusted with IL-6 instead of hs-CRP, and oxidized HDL and IL-6 were independently associated with composite CVD events. Findings resembled those from Cox proportional hazards modeling using time-varying covariates with HDL-C adjusted with IL-6. In conclusion, both oxidized HDL and apoB-apoA-I might be associated with CVD events in patients on prevalent HD, while associations of apoB-apoA-I with CVD events differed between models of apoB-apoA-I quartiles and 1-SD increases, and were influenced by IL-6.



Autor: Hirokazu Honda , Tsutomu Hirano, Masashi Ueda, Shiho Kojima, Shinichi Mashiba, Yasuyuki Hayase, Tetsuo Michihata, Kanji Shishido,

Fuente: http://plos.srce.hr/



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