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. 2025 Jul 8;14(14):4845.
doi: 10.3390/jcm14144845.

Associations Between Low-Density Lipoprotein Cholesterol Levels and Cardiovascular Outcomes in Patients Undergoing Dialysis: A Nationwide Cohort Study

Byung Sik Kim  1 , Jiyeong Kim  2   3 , Nayeon Choi  2 , Hyun-Jin Kim  1 , Jeong-Hun Shin  1
Affiliations

Associations Between Low-Density Lipoprotein Cholesterol Levels and Cardiovascular Outcomes in Patients Undergoing Dialysis: A Nationwide Cohort Study

Byung Sik Kim et al. J Clin Med. .

Abstract

Background/Objectives: Low-density lipoprotein cholesterol (LDL-C) is a causal factor in the development of atherosclerosis and a predictor of cardiovascular disease. However, the association between LDL-C levels and cardiovascular outcomes in patients undergoing dialysis remains controversial, with current guidelines advising against initiating statin therapy in this population. This study investigated the relationship between LDL-C levels and cardiovascular outcomes in Korean adults undergoing dialysis, using nationwide data. Methods: A total of 21,692 patients with end-stage kidney disease undergoing dialysis between 2009 and 2017 were identified from the Korean National Health Insurance Service database. Statin non-users (primary cohort) and users (secondary cohort) comprised 15,414 and 6278 patients, respectively. LDL-C levels were categorized, and cardiovascular outcomes including composites of cardiovascular death, myocardial infarction, and ischemic stroke were analyzed. Results: Among statin non-users, LDL-C levels > 100 mg/dL were significantly associated with an increased risk of the composite outcome, in a dose-dependent manner, compared with LDL-C levels < 70 mg/dL. Specifically, participants with LDL-C levels ≥ 160 mg/dL demonstrated a 43% increased risk of the composite outcome and a 2.25-fold higher risk of myocardial infarction compared to those with LDL-C levels < 70 mg/dL. Among statin users, LDL-C levels > 130 mg/dL were associated with an increased risk of the composite outcome. Conclusions: This study highlights the significant association between elevated LDL-C levels and adverse cardiovascular outcomes in patients undergoing dialysis. These findings underscore the importance of close monitoring and proactive management of LDL-C levels in this high-risk population. Future research should focus on developing tailored lipid-lowering strategies to improve cardiovascular outcomes in these patients.

Keywords: cardiovascular disease; dialysis; low-density lipoprotein cholesterol; outcome; statin.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart illustrating the study population selection. ESKD, end-stage kidney disease; LDL, low-density lipoprotein.
Figure 2
Figure 2
Kaplan–Meier survival curves for the primary cohort, stratified by LDL-C categories: (a) Composite outcome, including cardiovascular death, myocardial infarction, and ischemic stroke. (b) Cardiovascular death. (c) Myocardial infarction. (d) Ischemic stroke. LDL-C, low-density lipoprotein cholesterol.
Figure 3
Figure 3
Restricted cubic spline curves illustrating the continuous relationships between LDL-C levels and composite cardiovascular outcome, including cardiovascular death, myocardial infarction, and ischemic stroke. LDL-C, low-density lipoprotein cholesterol.
See this image and copyright information in PMC

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