Preheparin Serum Lipoprotein Lipase Mass as a Coronary Risk Factor in Patients With Chronic Kidney Disease

TL;DR

This study shows that lower preheparin serum lipoprotein lipase mass is a strong predictor of coronary artery disease events in patients with chronic kidney disease.

Contribution

The study demonstrates pre-LpL mass as a novel predictor of CAD events in CKD patients.

Findings

Lower pre-LpL mass was strongly associated with higher CAD event incidence in CKD patients.

Multivariate analysis confirmed pre-LpL mass as an independent risk factor for CAD events.

Inflammation and advanced glycation end products also significantly contributed to CAD risk.

Abstract

A significant association between lower preheparin serum lipoprotein lipase mass (pre-LpL mass) and coronary artery disease (CAD) has been reported in several clinical studies. However, the predictor of a pre-LpL mass as a CAD event in patients with chronic kidney disease (CKD) remains unclear. This prospective study aimed to investigate the clinical significance of a pre-LpL mass as a predictor of primary CAD events in patients with CKD.

A total of 480 CKD patients who did not develop CAD among outpatients who visited the clinic were enrolled. Using receiver operating characteristic curve analysis for a primary CAD event, participants were divided into two groups (low pre-LpL mass (group L, n = 211) or high pre-LpL mass (group H, n = 269)) by pre-LpL mass, and significance of a pre-LpL mass as a predictor for the primary CAD events was performed.

At baseline, skin autofluorescence, an indicator of advanced glycation end products in vivo, and high-sensitivity C-reactive protein (hs-CRP) concentration, an indicator of inflammation, were significantly higher in group L than in group H. During the median observation period of 107 months, 42 patients experienced a CAD event (group L: n = 31 (14.7%) vs. group H: n = 11 (4.1%)). Group L had a significantly higher incidence of primary CAD events than group H (P < 0.001, log-rank test). Furthermore, patients in group L were at a significantly higher risk of developing a primary CAD event than those in group H based on the multivariate Cox regression analysis (hazard ratio: 2.80; 95% confidence interval, 1.39–5.64; P = 0.003). However, skin autofluorescence and hs-CRP were also significant factors for a primary CAD event.

The prospective study showed that a decrease in pre-LpL mass is a useful predictor of a primary CAD event in patients with CKD. Additionally, background factors such as an increase in advanced glycation end products and inflammation are also an important factor in these patients.

Figures