Effects of Hypertension and Dyslipidemia on the Decline in Renal Function

Abstract

Experimental evidence suggests that in addition to hypertension, serum lipids might also accelerate the decline in renal function. We tested this hypothesis in 2702 dyslipidemic middle-aged men without renal disease participating in the Helsinki Heart Study, a coronary primary prevention trial. The decline in renal function was estimated from linear regression slopes based on reciprocals of 10 serum creatinine determinations over the study period. Renal function deteriorated 3% on average during the 5-year study, and hypertension accelerated this change. Subjects with an elevated ratio of low- to high-density lipoprotein cholesterol ( > 4.4) had a 20% faster decline than those with a ratio less than 3.2. Both the contribution of the lipoprotein ratio and the protective effect of high-density lipoprotein cholesterol alone remained significant in multiple regression analyses. In the study of joint effects the contribution of lipids was confined to subjects with simultaneous elevation of blood pressure and lipids. The results suggest that in addition to hypertension, blood lipids also modify the decline in renal function.

Lipoprotein Abnormalities Associated with Mild Impairment of Kidney Function in the Multi-Ethnic Study of Atherosclerosis

“…In cohort studies, lipid abnormalities have been associated with the incidence and progression of CKD (42)(43)(44). Moreover, lipid-lowering therapy has been associated with a modest decline in rate of CKD progression in clinical trials (45)(46)(47).…”

HMG-CoA Reductase Inhibitors and Renal Function

“…In the Physician's Health Study (29), researchers traced the probability of ensuing renal dysfunction in 4483 apparently healthy males (baseline plasma creatinine level 1.5 mg/dl). After 14 yr, the odds of renal disease progressing were directly related to baseline blood lipid levels (30). The Helsinki Heart Study documented an association between dyslipidemia and progressive kidney disease in 2702 middle-aged dyslipidemic men (30).…”

“…After 14 yr, the odds of renal disease progressing were directly related to baseline blood lipid levels (30). The Helsinki Heart Study documented an association between dyslipidemia and progressive kidney disease in 2702 middle-aged dyslipidemic men (30). The decline in renal function over 5 yr was faster by 20% in men with an LDL:HDL ratio Ͼ4.4 than in those with a ratio Ͻ3.2.…”

From Finland to Fatland

“…The first trial was from Finland-the Helsinki Heart Study-in which 2702 dyslipidemic (non-HDL cholesterol [non-HDL-C] Ͼ5.2 mmol/L) white men with normal renal function (creatinine Ͻ115 mol/L) were recruited (25). However, in the end, 30 subjects with plasma creatinine between 116 and 135 mol/L were included.…”