Association between baseline LDL-C and prognosis among patients with coronary artery disease and advanced kidney disease

Abstract

Background Lower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). However, LDL-C reduction does not decrease all-cause mortality among CAD patients when renal function impairs. The association between low baseline LDL-C (< 1.8 mmol/L) and mortality is unknown among patients with CAD and advanced kidney disease (AKD). The current study aimed to evaluate prognostic value of low baseline LDL-C level for all-cause death in these patients. Methods In this observational study, 803 CAD patients complicated with AKD (eGFR < 30 mL/min/1.73 m2) were enrolled between January 2008 to December 2018. Patients were divided into two groups (LDL-C < 1.8 mmol/L, n = 138; LDL-C ≥ 1.8 mmol/L, n = 665). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality. Results Among 803 participants (mean age 67.4 years; 68.5% male), there were 315 incidents of all-cause death during a median follow-up of 2.7 years. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for full 24 confounders (e.g., age, diabetes, heart failure, and dialysis, etc.), multivariate Cox regression analysis revealed that lower LDL-C level (< 1.8 mmol/L) was significantly associated with higher risk of all-cause death (adjusted HR, 1.38; 95% CI, 1.01–1.89). Conclusions Our data demonstrated that among patients with CAD and AKD, a lower baseline LDL-C level (< 1.8 mmol/L) did not present a higher survival rate but was related to a worse prognosis, suggesting a cautiousness of too low LDL-C levels among patients with CAD and AKD.

Methods on LDL particle isolation, characterization, and component fractionation for the development of novel specific oxidized LDL status markers for atherosclerotic disease risk assessment

“…This is also corroborated by the fact that not even statin medication correlates with the two OS markers in CKD-5d patients, which is in accordance with the observation of no beneficial effect by statins in any underlying CVD of these patients ( 79 – 81 ). This is corroborated also with our finding that LDL-C levels in CKD-5d patients correlate inversely with free cholesterol-OOH levels, and is also consistent with the finding that patients with advanced CKD and low LDL-C levels present higher risk for all cause death ( 16 ). All these findings further strengthen the disputed role of LDL-C as a reliable universal marker for CVDs development ( 12 , 13 , 15 ).…”

“…Despite the proven central causative role of oxLDL in atherosclerosis development (18), it has been only used in clinical studies as a prognostic marker for CVDs risk assessment but with contradictory results, possibly because it is being assessed non-specifically as a whole particle (16,(18)(19)(20)(21)(22)(23). This is mainly due to the lack of methods (a) for determination of specific oxidative modifications in the main protein/lipid components of oxLDL particles, and (b) for LDL fractionation into its main components.…”

“…Nonetheless, LDL-C is the traditional clinical marker thus far used in assessing CVDs risk development ( 11 ). However, numerous studies have pointed out the inefficacy of LDL-C in predicting CVDs risk ( 12 – 17 ), as it is also shown by cases where even subjects with normal LDL-C levels manifest cardiovascular events, even after statin treatment ( 11 , 12 , 14 , 16 ). Moreover, atherosclerosis shows great variability in its clinical expression at each LDL-C level ( 17 ).…”

Low density lipoprotein cholesterol and all-cause mortality rate: findings from a study on Japanese community-dwelling persons

“…In this study, comorbidities such as hypertriglyceridemia, low HDL cholesterolemia, and hyperuricemia were more frequently observed in individuals with the lowest LDL-C levels. Finally, the relationship between LDL-C and mortality from coronary artery disease has also been reported in a paradoxical hypothesis regarding the relationship with mortality, and patients with higher LDL-C at admission had not higher all-cause mortality compared to patients with normal or low LDL-C [ 32 , 33 ]. If high LDL-C were the cause, the effect should have been the opposite.…”

Effects of Serum LDL-C, CysC, and D-D in Patients with Coronary Atherosclerotic Heart Disease

“…Although coronary angiography is the gold standard for evaluating the severity of CHD, it has inevitable limitations as a high-cost, invasive procedure [ 3 ]. Studies have found that dyslipidemia is closely connected with CHD, and low-density lipoprotein cholesterol (LDL-C) is a crucial hazardous factor for CHD [ 4 ]. Meanwhile, serum cystatin C (CysC) can better predict the danger of cardiovascular events in high-risk patients than creatinine or glomerular filtration rate [ 5 ].…”