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. 2020 Apr 9;15(4):e0231328.
doi: 10.1371/journal.pone.0231328. eCollection 2020.

Lipid profiles and risk of major adverse cardiovascular events in CKD and diabetes: A nationwide population-based study

Yeonhee Lee  1   2 , Sehoon Park  3   4 , Soojin Lee  1   2 , Yaerim Kim  5 , Min Woo Kang  1   2 , Semin Cho  1   2 , Sanghyun Park  6 , Kyungdo Han  6 , Yong Chul Kim  1   7 , Seoung Seok Han  1   7 , Hajeong Lee  1   7 , Jung Pyo Lee  2   7   8 , Kwon Wook Joo  1   2   7 , Chun Soo Lim  2   7   8 , Yon Su Kim  3   4   7 , Dong Ki Kim  3   4   7
Affiliations

Lipid profiles and risk of major adverse cardiovascular events in CKD and diabetes: A nationwide population-based study

Yeonhee Lee et al. PLoS One. .

Abstract

The association of lipid parameters with cardiovascular outcomes and the impact of kidney function on this association have not been thoroughly evaluated in chronic kidney disease (CKD) patients with diabetes. We reviewed the National Health Insurance Database of Korea, containing the data of 10,505,818 subjects who received routine check-ups in 2009. We analyzed the association of lipid profile parameters with major adverse cardiovascular events (MACEs) risk and all-cause mortality in a nationally representative cohort of 51,757 lipid-lowering medication-naïve patients who had CKD and diabetes. Advanced CKD patients with eGFR <30 mL/min/1.73 m2 (n = 10,775) had lower serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and high-density lipoprotein cholesterol (HDL-c) but higher non-HDL-c levels and triglyceride (TG) to HDL-c ratios. There was a positive linear association between serum LDL-c and MACE risk in both early and advanced CKD patients (P <0.001 for trend), except for the category of LDL-c 30-49 mg/dL in extremely low LDL-c subgroup analyses. A U-shaped relationship was observed between serum LDL-c and all-cause mortality (the 4th and 8th octile groups; lowest hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.87-1.05 and highest HR 1.14, 95% CI 1.04-1.26, respectively). A similar pattern remained in both early and advanced CKD patients. The TG/HDL-c ratio categories showed a positive linear association for MACE risk in early CKD (P <0.001 for trend), but this correlation disappeared in advanced CKD patients. There was no correlation between the serum TG/HDL-c ratio and all-cause mortality in the study patients. The LDL-c level predicted the risk for MACEs and all-cause mortality in both early and advanced CKD patients with diabetes, although the patterns of the association differed from each other. However, the TG/HDL-c ratio categories could not predict the risk for either MACEs or all-cause mortality in advanced CKD patients with diabetes, except that the TG/HDL-c ratio predicted MACE risk in early CKD patients with diabetes.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of a cohort of 51,757 patients in the final analyses.
eGFR, estimated glomerular filtration rate.
Fig 2
Fig 2
Multivariate-adjusted MACE (A and B) and all-cause mortality (C and D) hazard ratios by serum LDL-c level in early CKD and advanced CKD patients.
Fig 3
Fig 3
Multivariate-adjusted MACE (A and B) and all-cause mortality (C and D) hazard ratios by serum TG/HDL-c ratio in early CKD and advanced CKD patients.
See this image and copyright information in PMC

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