HDL Cholesterol Is Not Associated with Lower Mortality in Patients with Kidney Dysfunction
Open accessAbstract
In the general population, HDL cholesterol (HDL-C) is associated with reduced cardiovascular events. However, recent experimental data suggest that the vascular effects of HDL can be heterogeneous. We examined the association of HDL-C with all-cause and cardiovascular mortality in the Ludwigshafen Risk and Cardiovascular Health study comprising 3307 patients undergoing coronary angiography. Patients were followed for a median of 9.9 years. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFRcreat-cys) equation. The effect of increasing HDL-C serum levels was assessed using Cox proportional hazard models. In participants with normal kidney function (eGFR>90 ml/min per 1.73 m(2)), higher HDL-C was associated with reduced risk of all-cause and cardiovascular mortality and coronary artery disease severity (hazard ratio [HR], 0.51, 95% confidence interval [95% CI], 0.26-0.92 [P=0.03]; HR, 0.30, 95% CI, 0.13-0.73 [P=0.01]). Conversely, in patients with mild (eGFR=60-89 ml/min per 1.73 m(2)) and more advanced reduced kidney function (eGFR<60 ml/min per 1.73 m(2)), higher HDL-C did not associate with lower risk for mortality (eGFR=60-89 ml/min per 1.73 m(2): HR, 0.68, 95% CI, 0.45-1.04 [P=0.07]; HR, 0.84, 95% CI, 0.50-1.40 [P=0.50]; eGFR<60 ml/min per 1.73 m(2): HR, 1.18, 95% CI, 0.60-1.81 [P=0.88]; HR, 0.82, 95% CI, 0.40-1.69 [P=0.60]). Moreover, Cox regression analyses revealed interaction between HDL-C and eGFR in predicting all-cause and cardiovascular mortality (P=0.04 and P=0.02, respectively). We confirmed a lack of association between higher HDL-C and lower mortality in an independent cohort of patients with definite CKD (P=0.63). In summary, higher HDL-C levels did not associate with reduced mortality risk and coronary artery disease severity in patients with reduced kidney function. Indeed, abnormal HDL function might confound the outcome of HDL-targeted therapies in these patients.
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In patients with diabetes mellitus, coronary disease, chronic renal insufficiency, cardiovascular risk factors and disorders, the function of HDL is impaired.
“In patients with diabetes mellitus, coronary disease, chronic renal insufficiency, cardiovascular risk factors and disorders, the function of HDL is impaired [9, 61, 70–74].”
From HDL cholesterol: reappraisal of its clinical relevance (2017) · cites this paper as [72]
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- Authors
- Zewinger, S., Speer, T., Kleber, M. E., Scharnagl, H., Woitas, R., Lepper, P. M., Pfahler, K., Seiler, S., Heine, G. H., März, W., Silbernagel, G., & Fliser, D.
- Affiliations
- Heidelberg University (DE)
- Medical University of Graz (AT)
- University of Bonn (DE)
- Universitätsklinikum des Saarlandes (DE)
- University Hospital of Bern (CH)
- Corresponding author
- Zewinger, Stephen
- Speer, Thimoteus
- Pfahler, Karolin
- Seiler, Sarah
- Heine, Gunnar H.
- Silbernagel, Günther
- Fliser, Danilo
- ORCID
- Venue
- Journal of the American Society of Nephrology
- Published
- 2014-05
- Volume
- 25
- Issue
- 5
- Pages
- 1073-1082
- ISSN
- 1046-6673 (ISSN-L)
- PMC
- PMC4005298
- OpenAlex
- W2165758797
- Cited by
- 103
- References
- 32
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 4 · 2023: 9 · 2022: 6 · 2021: 5 · 2020: 11 · 2019: 13 · 2018: 9 · 2017: 13 · 2016: 9 · 2015: 8 · 2014: 6
- FWCI
- 11.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Paraoxonase enzyme and polymorphisms
- Keywords
- HDL cholesterol, chronic kidney disease, estimated glomerular filtration rate, all-cause mortality, cardiovascular mortality, coronary artery disease severity, cardiovascular risk prediction, coronary angiography patients, cardiovascular risk stratification, cardiovascular risk reclassification
- MeSH terms
- Aged, Cardiovascular Diseases, Female, Follow-Up Studies, Germany, Humans, Cholesterol, HDL, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Coronary Angiography, Renal Insufficiency, Chronic, ErbB Receptors
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