Dyslipidemia is a strong predictor of myocardial infarction in subjects with chronic kidney disease

Abstract

Aim. To evaluate dyslipidemia as predictor of myocardial infarction (MI) in subjects with or without chronic kidney disease (CKD). Methods. In 142,394 middle-aged Swedes referred for laboratory evaluation, glomerular filtration rates (GFR) were estimated using the Modification of Diet in Renal Disease study equation. CKD was defined as GFR 15–60 mL/min/1.73 m². Subjects were stratified into presence or absence of CKD, and lipid measures were related to MI using Cox's proportional hazards regression. Results. During 12 years of follow-up there were 5,466 MIs. The adjusted hazard ratio for MI for the highest versus the lowest quartile of the apolipoprotein (apo) B/apoA-1 ratio among individuals without CKD was 2.88 (95% confidence interval 2.54–3.26) and for those with CKD 3.35 (2.25–4.91). The corresponding estimates for the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio were 3.13 (2.78–3.52) and 3.54 (2.43–5.17), respectively. Receiver operator characteristics analyses showed an advantage in the prediction of MI for the apoB/apoA-1 ratio as compared to conventional lipids (P < 0.0001). Conclusions. The ratio of apoB/apoA-1, the ratio of total cholesterol/HDL cholesterol, and non-HDL cholesterol were all strong predictors of myocardial infarction, both among subjects with and without renal dysfunction, with a possible advantage for the apoB/apoA-1 ratio.

Key words::

• Apolipoproteins
• kidney
• myocardial infarction
• prognosis
• risk factors

Declaration of interest: The authors state no conflict of interest and have received no payment in preparation of this manuscript.

Appendix

Appendix Table I. Hazard ratios^a of myocardial infarction with 95% confidence intervals in relation to quartiles of lipoproteins and lipid ratios in 6,442 individuals with measured HDL cholesterol without stratification for renal function.

Appendix Table II. Hazard ratios ^a of myocardial infarction with 95% confidence intervals in relation to quartiles of lipoproteins and lipid ratios by level of estimated glomerular filtration rate in 89,528 individuals known to be fasting at the time of laboratory evaluation.