Increased Prevalence of Coronary Heart Disease in Analgesic Nephropathy: Relation to Hypertension, Hypertriglyceridemia and Combined Hyperlipidemia

Abstract

The prevalence of coronary heart disease (58%) in 43 patients with analgesic nephropathy with moderate to severe chronic renal failure was significantly higher than in the general population of the same age and sex. Mean serum triglyceride concentration and mean diastolic blood pressure were significantly higher in the group with coronary heart disease (214 mg/dl and 102 mm Hg, respectively) than in the group without it (162 and 94). Serum triglyceride values correlated inversely with GFR, indicating that hypertriglyceridemia was largely due to associated chronic renal failure; a specific effect of analgesic abuse on prevalence of heart disease, noted by others, could not be assessed in the absence of GFR-matched controls. The prevalence of coronary heart disease was significantly higher (81 %) in the group with combined hyperlipidemia (hypertriglyceridemia and hypercholesteremia) compared to the groups without it or with normal serum triglyceride concentrations (44 and 41%, respectively). Hypotryptophanemia (a possible cause of hyperlipidemia in the nephrotic syndrome) was present in 77% of patients.

Hypercholesterolaemia and Hypertriglyceridaemia in Patients with Analgesic Nephropathy

“…A reduction in triglyceride metabolism by inhibition of lipoprotein lipase [24], stimulation of hepatic triglyceride synthesis in nephrotic syndrome [15], increased produc tion of very low density lipoproteins as a consequence of elevated basal plasma insulin concentrations in renal in sufficiency [3,33] and a hyperiipaemic effect of steroid therapy in patients after renal transplantation are thought to be possible causes [4,37], Hypercholesterolaemia and hypertriglyceridaemia ap pear to be important risk factors in the development of atherosclerosis and coronary heart disease [10.12,36,41, 42], This has also been observed in renal diseases with hyperlipaemia, patients with nephrotic syndrome [1] and patients after renal transplantation [25] are reported to manifest an accelerated development of atherosclerotic heart disease. A similar phenomenon in patients with ad vanced renal failure undergoing regular haemodialysis [5,31,32] has been unconfirmed by Burke et al [11], Recently in this journal an increased 'coronary risk' has also been reported in patients with analgesic nephropathy [26,30]. During this same period, we have followed a series of patients with analgesic nephropathy presenting with high cholesterol and triglyceride concentrations in plasma and only moderately impaired renal function.…”

Reduced, Free and Total Fractions of Homocysteine and Other Thiol Compounds in Plasma from Patients with Renal Failure

“…After a methyl transfer reaction (trans methylation), adenosyl homocysteine is hydrolyzed to Elevated plasma sulfur amino acids in general have been reported in patients with chronic renal failure [9][10][11][12], although most interest has recently been focused on homocysteine, which has also shown elevated concentra tions exhibiting a positive relationship to the extent of renal insufficiency [13][14][15]. Treatment with a single dialy sis, renal transplantation or folate supplementation de creased the elevated concentrations of plasma homocys t e i n e^, [16][17][18], Patients with chronic renal failure have a well-defined high risk of premature vascular disease [19][20], The mechanisms are unclear, although hyperten sion and disorder of lipid metabolism may be relevant. Among other factors that could enhance the risk of vascu lar disease in chronic renal failure is mild hyperhomocysteinemia.…”

Increased Uptake of Cholesterol and Increased Mineral Content in the Aorta of Long-Term Uremic Rabbits

“…The first reports of an abnormally high incidence of atherosclerotic complications in dialysis patients [1][2][3] were initially interpreted to indicate an accelerated atherosclero sis in these patients but this concept has recently been questioned [4,5]. In hypercholesterolemic uremic rabbits we could not demonstrate any significant effect of renal insufficiencyduring lOweeks, neither on the aortic cholesterol concentration nor on the aortic uptake of labelled plasma cholesterol [6], The present study was undertaken to study the possible effect of long-term renal insufficiency of up to 8 monthsdurationontheaorticaccumulationofcholesterol in normocholesterolemic rabbits.…”