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

Figures & data

Table I. Characteristics of study population in relation to glomerular filtration rates estimated by the Modification of Diet In Renal Disease study equation.

		Estimated GFR (mL/min/1.73 m^2)
	All	> 90	60–90	15–60
All individuals:	142,394	49,411	87,145	5,838
Percent of study population	100	34.7	61.2	4.1
Age, (years)^a	47.7 (13.5)	41.3 (12.0)	50.2 (12.5)	64.5 (12.2)
Female sex, (%)	43.3	28.9	49.3	77.1
Diabetes mellitus (%)^b	3.3	2.5	3.4	8.1
Estimated GFR, (mL/min/1.73 m^2)^a	85.1 (15.8)	102 (10.8)	77.7 (7.7)	53.3 (6.7)
Glucose, (mmol/L)^a	5.07 (1.33)	4.97 (1.13)	5.09 (1.33)	5.56 (2.35)
Lipid measures men:^a
Total cholesterol (mmol/L)	5.84 (1.15)	5.64 (1.16)	5.99 (1.12)	6.12 (1.34)
Triglycerides (mmol/L)	1.54 (0.99)	1.45 (0.97)	1.59 (1.00)	1.91 (1.12)
LDL cholesterol (mmol/L)	3.75 (1.05)	3.58 (1.05)	3.88 (1.02)	3.98 (1.20)
HDL cholesterol (mmol/L)	1.40 (0.41)	1.41 (0.40)	1.40 (0.42)	1.29 (0.45)
Non-HDL cholesterol (mmol/L)	4.44 (1.22)	4.24 (1.22)	4.59 (1.19)	4.84 (1.37)
Total cholesterol/HDL cholesterol ratio	4.69 (2.53)	4.49 (2.39)	4.83 (2.59)	5.58 (3.42)
ApoB (g/L)	1.29 (0.35)	1.23 (0.35)	1.34 (0.33)	1.40 (0.38)
ApoA-1 (g/L)	1.37 (0.21)	1.36 (0.21)	1.38 (0.21)	1.35 (0.24)
ApoB/apoA-1 ratio	0.97 (0.30)	0.93 (0.30)	1.00 (0.30)	1.06 (0.32)
Lipid measures women:^a
Total cholesterol (mmol/L)	5.83 (1.22)	5.40 (1.14)	5.90 (1.20)	6.46 (1.28)
Triglycerides (mmol/L)	1.17 (0.73)	1.04 (0.65)	1.17 (0.72)	1.54 (0.91)
LDL cholesterol (mmol/L)	3.59 (1.12)	3.25 (1.03)	3.65 (1.11)	4.11 (1.21)
HDL cholesterol (mmol/L)	1.71 (0.43)	1.69 (0.40)	1.73 (0.43)	1.66 (0.48)
Non-HDL cholesterol (mmol/L)	4.11 (1.26)	3.72 (1.15)	4.17 (1.24)	4.80 (1.36)
Total cholesterol/HDL cholesterol ratio	3.66 (1.62)	3.41 (1.43)	3.67 (1.58)	4.34 (2.21)
ApoB (g/L)	1.19 (0.35)	1.07 (0.32)	1.21 (0.34)	1.37 (0.37)
ApoA-1 (g/L)	1.52 (0.24)	1.48 (0.23)	1.52 (0.24)	1.53 (0.25)
ApoB/apoA-1 ratio	0.80 (0.28)	0.74 (0.25)	0.81 (0.27)	0.93 (0.31)

To convert total, LDL and HDL cholesterol to mg/dL, divide by 0.02586; to convert triglycerides to mg/dL divide by 0.01129 and to convert glucose to mg/dL divide by 0.05551.

^aAge, GFR, lipid ratios and all laboratory values are given as means with standard deviations.

^bIncludes individuals with fasting serum glucose > 7.0 mmol/L (> 126 mg/dL) or prior hospitalization for diabetes.

GFR = glomerular filtration rate; LDL = low-density lipoprotein; HDL = high-density lipoprotein; Apo = apolipoprotein.

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. All individuals (n = 142,394).

	Quartile
	1	2	3	4
Apolipoprotein B (g/L)^b	0.84 [<1.00]	1.10 [1.00–1.21]	1.33 [1.22–1.45]	1.72 [>1.45]
No. of MIs	312	950	1,541	2,663
GFR ≥ 60	1.00	1.50 (1.31–1.72)	1.92 (1.68–2.20)	2.58 (2.22–3.00)
< 60	1.00	1.83 (1.12–3.00)	2.44 (1.50–3.96)	3.55 (2.13–5.90)
Apolipoprotein A-1 (g/L)	1.16 [<1.28]	1.35 [1.28–1.41]	1.48 [1.42–1.56]	1.74 [>1.56]
No. of MIs	1,865	1,417	1,131	1,053
GFR ≥ 60	1.00	0.72 (0.67–0.77)	0.57 (0.52–0.62)	0.47 (0.43–0.51)
< 60	1.00	0.78 (0.61–0.98)	0.67 (0.52–0.85)	0.42 (0.33–0.55)
ApoB/apoA-1 ratio	0.56 [<0.69]	0.77 [0.69–0.85]	0.95 [0.86–1.06]	1.30 [>1.06]
No. of MIs	389	802	1,523	2,752
GFR ≥ 60	1.00	1.41 (1.24–1.61)	1.99 (1.76–2.24)	2.88 (2.54–3.26)
< 60	1.00	1.42 (0.93–2.15)	2.47 (1.69–3.60)	3.35 (2.25–4.91)
Total cholesterol (mmol/L)	4.44 [<5.10]	5.41 [5.10–5.73]	6.13 [5.74–6.50]	7.36 [>6.50]
No. of MIs	539	974	1,504	2,449
GFR ≥ 60	1.00	1.38 (1.24–1.54)	1.68 (1.52–1.87)	2.24 (2.03–2.48)
< 60	1.00	1.25 (0.87–1.81)	1.39 (0.98–1.97)	1.81 (1.30–2.53)
Triglycerides (mmol/L)	0.58 [<0.84]	0.94 [0.84–1.21]	1.38 [1.22–1.69]	2.55 [>1.69]
No. of MIs	505	1,130	1,477	2,354
GFR ≥ 60	1.00	1.25 (1.12–1.40)	1.71 (1.54–1.90)	1.96 (1.76–2.18)
< 60	1.00	0.88 (0.60–1.30)	1.18 (0.82–1.71)	1.43 (1.00–2.04)
LDL cholesterol (mmol/L)	2.39 [<2.92]	3.27 [2.92–3.60]	3.96 [3.61–4.35]	5.10 [>4.35]
No. of MIs	447	1,017	1,502	2,500
GFR ≥ 60	1.00	1.58 (1.44–2.34)	2.02 (1.77–2.30)	3.06 (2.61–3.59)
< 60	1.00	1.81 (1.22–2.69)	2.14 (1.43–3.20)	3.11 (1.95–4.95)
HDL cholesterol (mmol/L)	0.99 [<1.26]	1.40 [1.26–1.52]	1.65 [1.53–1.80]	2.11 [>1.80]
No. of MIs	2,204	1,336	1,080	846
GFR ≥ 60	1.00	0.70 (0.64–0.75)	0.56 (0.52–0.61)	0.40 (0.36–0.44)
< 60	1.00	0.71 (0.56–0.90)	0.58 (0.44–0.76)	0.39 (0.29–0.52)
Non-HDL cholesterol	2.81 [<3.39]	3.81 [3.39–4.20]	4.63 [4.21–5.09]	5.95 [>5.10]
No. of MIs	334	966	1,553	2,613
GFR ≥ 60	1.00	1.80 (1.58–2.06)	2.41 (2.09–2.77)	3.54 (2.98–4.19)
< 60	1.00	1.60 (1.01–2.53)	2.13 (1.36–3.34)	3.40 (2.05–5.63)
TC/HDL cholesterol	2.58 [<3.01]	3.36 [3.01–3.72]	4.20 [3.73–4.78]	6.85 [>4.78]
No. of MIs	421	864	1,547	2,634
GFR ≥ 60	1.00	1.44 (1.27–1.63)	2.11 (1.88–2.38)	3.13 (2.78–3.52)
< 60	1.00	1.59 (1.05–2.40)	2.28 (1.55–3.35)	3.54 (2.43–5.17)

GFR was estimated by the Modification of Diet in Renal Disease study equation.

^aAdjusted for age, gender, glucose, triglycerides and total cholesterol.

^bLipoprotein values and ratios are given as means with range in square brackets.

Apo = apolipoprotein; GFR = glomerular filtration rate; LDL = low-density lipoprotein; HDL = high-density lipoprotein; TC = total cholesterol.

Figure 1. A: Hazard ratios for myocardial infarction for each quartile of the apoB/apoA-1 ratio, among men, with or without chronic kidney disease. Hazard ratios were calculated in relation to individuals in the quartile with the lowest apoB/apoA-1 ratio and no chronic kidney disease. B: Hazard ratios for myocardial infarction for each quartile of the apoB/apoA-1 ratio, among women, with or without chronic kidney disease. Hazard ratios were calculated in relation to individuals in the quartile with the lowest apoB/apoA-1 ratio and no chronic kidney disease.

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.

	Quartile
	1	2	3	4
	HR	HR (95% CI)	HR (95% CI)	HR (95% CI)
ApoB/apoA-1 ratio	1.00	2.19 (1.18–4.06)	2.57 (1.37–4.83)	5.04 (2.58–9.85)
Total cholesterol (mmol/L)	1.00	0.83 (0.49–1.42)	1.21 (0.75–1.93)	1.06 (0.64–1.76)
LDL cholesterol (mmol/L)	1.00	1.65 (0.89–3.08)	2.67 (1.28–5.57)	3.61 (1.32–9.87)
HDL cholesterol (mmol/L)	1.00	0.69 (0.44–1.08)	0.45 (0.27–0.74)	0.34 (0.20–0.58)
Non-HDL cholesterol	1.00	2.20 (1.16–4.17)	3.01 (1.38–6.54)	6.41 (2.24–18.3)
TC/HDL cholesterol	1.00	1.84 (1.01–3.35)	2.61 (1.44–4.73)	3.91 (2.04–7.52)

^aAdjusted for age, gender, glucose, triglycerides, and total cholesterol.

Apo = apolipoprotein; HDL = high-density lipoprotein; TC = total cholesterol; CI = confidence interval.

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.

	Quartile
	1	2	3	4
	HR	HR (95% CI)	HR (95% CI)	HR (95% CI)
Apo B/apoA-1 ratio
GFR ≥ 60	1.00	1.92 (1.64–2.24)	3.01 (2.59–3.49)	4.61 (3.96–5.37)
< 60	1.00	2.43 (1.39–4.27)	4.41 (2.60–7.50)	6.48 (3.79–11.1)
Total cholesterol (mmol/L)
GFR ≥ 60	1.00	1.53 (1.34–1.75)	1.92 (1.68–2.18)	2.20 (1.93–2.49)
< 60	1.00	0.93 (0.61–1.43)	1.11 (0.74–1.66)	1.31 (0.90–1.93)
LDL cholesterol (mmol/L)
GFR ≥ 60	1.00	2.03 (1.75–2.36)	2.95 (2.51–3.46)	5.06 (4.16–6.16)
< 60	1.00	1.92 (1.18–3.12)	2.43 (1.49–3.96)	3.42 (1.95–6.00)
HDL cholesterol (mmol/L)
GFR ≥ 60	1.00	0.71 (0.65–0.77)	0.53 (0.48–0.59)	0.36 (0.32–0.40)
< 60	1.00	0.70 (0.54–0.93)	0.49 (0.36–0.68)	0.36 (0.26–0.50)
Non-HDL cholesterol
GFR ≥ 60	1.00	2.33 (1.98–2.75)	3.48 (2.93–4.13)	5.88 (4.78–7.24)
< 60	1.00	1.61 (0.94–2.76)	2.20 (1.29–3.75)	3.85 (2.10–7.06)
TC/HDL cholesterol
GFR ≥ 60	1.00	1.78 (1.53–2.06)	2.90 (2.52–3.33)	5.05 (4.38–5.83)
< 60	1.00	2.14 (1.30–3.53)	3.15 (1.96–5.07)	5.42 (3.35–8.77)

GFR was estimated by the Modification of Diet in Renal Disease study equation.

^aAdjusted for age, gender, glucose, triglycerides, and total cholesterol.

Apo = apolipoprotein; GFR = glomerular filtration rate; HDL = high-density lipoprotein; TC = total cholesterol; CI = confidence interval.