Lipoprotein(a) is an independent risk factor for cardiovascular disease in hemodialysis patients.

Abstract

BACKGROUND Although serum lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis in the general population and Lp(a) levels are increased in hemodialysis patients, an association of Lp(a) with the risk of clinical events attributed to atherosclerosis has not been established in the chronic hemodialysis patient population. We therefore determined the association between Lp(a) levels and the risk of clinical events of presumed atherosclerotic etiology in a prospective study of an outpatient hemodialysis population. METHODS AND RESULTS Lp(a) was measured by radioimmunoassay in a baseline cardiovascular disease risk assessment in a consecutive series of 129 hemodialysis patients. The relation between baseline Lp(a) and clinical events of presumed atherosclerotic etiology was determined during 48 months of follow-up. Hemodialysis patients had a median Lp(a) concentration that was approximately four times as high as the median Lp(a) concentration in normal controls and twice as high as the levels in controls with angiographic evidence of coronary artery disease [median Lp(a), 38.4 versus 16.9 mg/dl; p less than 0.001]. Baseline Lp(a) levels were no different in participants with or with no history of a previous clinical event at the time of the baseline examination. However, baseline Lp(a) concentration (p less than 0.001) and a history of atherosclerotic clinical events (p = 0.001) were associated with clinical events during the period of follow-up. In contrast, baseline serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, age, gender, race, or duration of hemodialysis were unrelated to this risk in the prospective study. Stepwise multiple logistic regression analysis demonstrated that serum Lp(a) concentration (p = 0.001) and the presence of a previous clinical event (p = 0.004) were the only independent contributors to the risk of a clinical event during the period of follow-up. CONCLUSIONS Lp(a) is an independent risk factor for clinical events attributed to atherosclerotic cardiovascular disease in patients receiving chronic hemodialysis treatment of end-stage renal disease.

Lipid profile and lipoprotein(a) in chronic renal failure patients with and without hemodialysis

“…8,11 Some studies also reported that Lp(a) level did not vary before and after hemodialysis. 5,12 In our study we find elevated levels of Lp(a) in CRF patients with and without hemodialysis as compared to controls. The difference was found highly significant.…”

“…Lp(a) plays a causal role in the development of atherosclerosis and is a potentially modifiable cardiovascular disease risk factor in hemodialysed CRF patients. 5 Cardiovascular disease constitutes the major cause of death in patients with ESRD and it is still higher in dialysis patients than in post transplantation patients due to abnormalities in lipids and lipoproteins structure and metabolism. 6 Controversies exist regarding Lp(a) levels in CRF patients with and without hemodialysis.…”

“…There are few studies that showed Lp(a) levels were elevated in CRF patients, 7,8,9 Lp(a) levels were elevated in hemodialysed patients, 10 Lp(a) levels were decreased after hemodialysis 8,11 and Lp(a) levels did not vary before and after hemodialysis. 5,12 With the implication of plasma lipids and lipoproteins in the pathogenesis of atherosclerosis and ischemic heart disease, it becomes worthwhile to study the behavior of various lipid fractions in CRF patients. 13 Thus the present study was undertaken to compare the levels of Lp(a) and lipid profile in CRF patients with and without hemodialysis.…”

Association of serum fetuin A with truncal obesity and dyslipidemia in non-diabetic hemodialysis patients

“…This may partially explain why the association between fetuin A and dyslipidemia occurs mainly on the non-HDL-C and TG components. On the relationship between dyslipidemia and CV mortality (29)(30)(31), the relationship between high fetuin A and CV mortality warrants further investigation through larger studies because its reverse impact on CV mortality related to malnutrition and CV calcification in dialysis patients has been shown in previous studies (3,18).…”

Impact of Dyslipidemia in End-Stage Renal Disease

“…A combination of elevated LDL-C, elevated triglycerides, and low HDL-C seems to be particularly atherogenic. In addition, high concentrations of Lp(a), a cholesterol-rich lipoprotein with an LDL particle linked to apolipoprotein (a), has been associated with high risk for CAD (24,25). The compelling evidence linking dyslipidemia with CAD and showing benefits of cholesterol reduction or lipid-normalizing strategies led to the recommendation by the American Heart Association that patients with CAD be treated with lipid-lowering agents (26).…”