Effect of renal denervation on the lipid profile in patients with or without coronary artery disease

TL;DR

Renal denervation improves lipid profiles in hypertensive patients, especially those with coronary artery disease, independent of blood pressure reduction.

Contribution

Demonstrates that RDN leads to significant lipid improvements in CAD patients beyond its known effects on hypertension.

Findings

RDN significantly reduced total cholesterol, LDL, and triglycerides in all patients.

Patients with CAD showed greater reductions in total cholesterol and LDL compared to those without CAD.

Lipid improvements occurred independently of blood pressure changes.

Abstract

Sympathetic overactivation plays a critical role in the pathophysiology of various conditions, such as arterial hypertension, chronic kidney disease, coronary artery disease (CAD), diabetes, metabolic syndrome, and dyslipidemia. Initially developed for hypertension management, renal denervation (RDN) has also been associated with metabolic improvements. Preclinical studies in rodent models suggest that RDN may improve lipid profiles by reducing sympathetic activity. This study analyses the effect of RDN on lipid profiles in hypertensive patients with or without CAD.

This analysis includes 122 hypertensive patients with (n = 30) or without CAD (n = 92). All patients underwent radiofrequency, ultrasound, or alcohol-injection-based RDN. Fasting lipid profile, including total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and non-HDL levels was measured at baseline and 6 months after RDN in parallel to office and 24-h ambulatory blood pressure (BP).

Six months after RDN, the total cohort showed significant lipid profile improvements. The total cholesterol levels decreased by 10.3 ± 26.3 mg/dL (p < 0.001), LDL by 7.0 ± 20.4 mg/dL (p < 0.001), and triglycerides by 30.7 ± 69.4 mg/dL (p < 0.001), while non-HDL cholesterol levels declined by 7.6 ± 26.3 mg/dL (p = 0.002). These changes were independent of BP reduction. In patients with CAD, total cholesterol levels declined by 21.7 ± 29.1 mg/dL (p < 0.001), triglycerides by 40.7 ± 80.0 mg/dL (p = 0.009), LDL by 15.2 ± 22.0 mg/dL (p < 0.001), HDL by 2.8 ± 4.7 mg/dL (p = 0.003), and non-HDL by 15.0 ± 34 .8 mg/dL (p = 0.021). Reductions in total cholesterol and LDL were greater in CAD than in non-CAD (p = 0.011 and p = 0.006).

We observed a significant improvement in lipid profiles in hypertensive patients with CAD after RDN. This improvement may represent an additive benefit of RDN in hypertensive patients with CAD.

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