Triglyceride to high-density lipoprotein cholesterol ratio predicts cardiovascular outcomes in prevalent dialysis patients

Hung-Yuan Chen, Wan-Chuan Tsai, Yen-Ling Chiu, Shih-Ping Hsu, Mei-Fen Pai, Ju-Yeh Yang, Yu-Sen Peng, Hung-Yuan Chen, Wan-Chuan Tsai, Yen-Ling Chiu, Shih-Ping Hsu, Mei-Fen Pai, Ju-Yeh Yang, Yu-Sen Peng

Abstract

Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, an indicator of atherogenic dyslipidemia, is a predictor of cardiovascular (CV) outcomes in the general population and has been correlated with atherosclerotic events. Whether the TG/HDL-C ratio can predict CV outcomes and survival in dialysis patients is unknown. We performed this prospective, observational cohort study and enrolled 602 dialysis patients (539 hemodialysis and 63 peritoneal dialysis) from a single center in Taiwan followed up for a median of 3.9 years. The outcomes were the occurrence of CV events, CV death, and all-cause mortality during follow-up. The association of baseline TG/HDL-C ratio with outcomes was explored with Cox regression models, which were adjusted for demographic parameters and inflammatory/nutritional markers. Overall, 203 of the patients experienced CV events and 169 patients died, of whom 104 died due to CV events. Two hundred fifty-four patients reached the composite CV outcome. Patients with higher TG/HDL-C levels (quintile 5) had a higher incidence of CV events (adjusted hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.19-3.47), CV mortality (adjusted HR 1.91, 95% CI 1.07-3.99), composite CV outcome (adjusted HR 2.2, 95% CI 1.37-3.55), and all-cause mortality (adjusted HR 1.94, 95% CI 1.1-3.39) compared with the patients in quintile 1. However, in diabetic dialysis patients, the TG/HDL-C ratio did not predict the outcomes. The TG/HDL-C ratio is a reliable and easily accessible predictor to evaluate CV outcomes and survival in prevalent nondiabetic dialysis patients. ClinicalTrials.gov: NCT01457625.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Association between the adjusted HRs of the composite CV outcomes (with log-transformation) and the TG/HDL-C ratio in dialysis patients with or without diabetes. In the diabetic dialysis patients, the TG/HDL-C ratio did not have an association with the composite outcome. CV = cardiovascular, DM = diabetes mellitus, HDL-C = high-density lipoprotein cholesterol, HR = hazard ratio, TG = triglyceride.
FIGURE 2
FIGURE 2
ROC curve of the TG/HDL-C ratio and non-HDL-C level as predictors of the outcomes. The TG/HDL-C ratio had a superior predictive performance for composite CV outcome and all-cause mortality (P = 0.01 and 0.02, respectively, by DeLong test). CV = cardiovascular, HDL-C = high-density lipoprotein cholesterol, ROC = receiver operating characteristic, TG = triglyceride.

References

    1. Ballantyne CM, Olsson AG, Cook TJ, et al. Influence of low high-density lipoprotein cholesterol and elevated triglyceride on coronary heart disease events and response to simvastatin therapy in 4S. Circulation 2001; 104:3046–3051.
    1. Manninen V, Tenkanen L, Koskinen P, et al. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation 1992; 85:37–45.
    1. Sirimarco G, Labreuche J, Bruckert E, et al. Atherogenic dyslipidemia and residual cardiovascular risk in statin-treated patients. Stroke 2014; 45:1429–1436.
    1. Frohlich J, Dobiasova M. Fractional esterification rate of cholesterol and ratio of triglycerides to HDL-cholesterol are powerful predictors of positive findings on coronary angiography. Clin Chem 2003; 49:1873–1880.
    1. Hanak V, Munoz J, Teague J, et al. Accuracy of the triglyceride to high-density lipoprotein cholesterol ratio for prediction of the low-density lipoprotein phenotype B. Am J Cardiol 2004; 94:219–222.
    1. McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005; 96:399–404.
    1. Gaziano JM, Hennekens CH, O’Donnell CJ, et al. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation 1997; 96:2520–2525.
    1. Jeppesen J, Hein HO, Suadicani P, et al. Low triglycerides-high high-density lipoprotein cholesterol and risk of ischemic heart disease. Arch Intern Med 2001; 161:361–366.
    1. Barzi F, Patel A, Woodward M, et al. A comparison of lipid variables as predictors of cardiovascular disease in the Asia Pacific region. Ann Epidemiol 2005; 15:405–413.
    1. Bittner V, Johnson BD, Zineh I, et al. The triglyceride/high-density lipoprotein cholesterol ratio predicts all-cause mortality in women with suspected myocardial ischemia: a report from the Women's Ischemia Syndrome Evaluation (WISE). Am Heart J 2009; 157:548–555.
    1. Barter PJ, Caulfield M, Eriksson M, et al. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med 2007; 357:2109–2122.
    1. Group AS, Ginsberg HN, Elam MB, et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362:1563–1574.
    1. Investigators A-H, Boden WE, Probstfield JL, et al. Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. N Engl J Med 2011; 365:2255–2267.
    1. Tonelli M, Muntner P, Lloyd A, et al. Association between LDL-C and risk of myocardial infarction in CKD. J Am Soc Nephrol 2013; 24:979–986.
    1. Wanner C, Tonelli M. Kidney Disease: Improving Global Outcomes Lipid Guideline Development Work Group Members. KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient. Kidney Int 2014; 85:1303–1309.
    1. Wanner C, Krane V, Marz W, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005; 353:238–248.
    1. Fellstrom BC, Jardine AG, Schmieder RE, et al. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009; 360:1395–1407.
    1. Kovesdy CP, Anderson JE, Kalantar-Zadeh K. Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: effects of case mix and the malnutrition–inflammation–cachexia syndrome. J Am Soc Nephrol 2007; 18:304–311.
    1. Kilpatrick RD, McAllister CJ, Kovesdy CP, et al. Association between serum lipids and survival in hemodialysis patients and impact of race. J Am Soc Nephrol 2007; 18:293–303.
    1. Postorino M, Marino C, Tripepi G, et al. Abdominal obesity modifies the risk of hypertriglyceridemia for all-cause and cardiovascular mortality in hemodialysis patients. Kidney Int 2011; 79:765–772.
    1. Moradi H, Streja E, Kashyap ML, et al. Elevated high-density lipoprotein cholesterol and cardiovascular mortality in maintenance hemodialysis patients. Nephrol Dial Transplant 2014; 29:1554–1562.
    1. Silbernagel G, Genser B, Drechsler C, et al. HDL cholesterol, apolipoproteins, and cardiovascular risk in hemodialysis patients. J Am Soc Nephrol 2014; 26:484–492.
    1. Chen HY, Chiu YL, Chuang YF, et al. Association of low serum fetuin A levels with poor arteriovenous access patency in patients undergoing maintenance hemodialysis. Am J Kidney Dis 2010; 56:720–727.
    1. Chen HY, Chiu YL, Hsu SP, et al. Association of serum fetuin A with truncal obesity and dyslipidemia in non-diabetic hemodialysis patients. Eur J Endocrinol 2009; 160:777–783.
    1. Chiu YL, Chen HY, Chuang YF, et al. Association of uraemic pruritus with inflammation and hepatitis infection in haemodialysis patients. Nephrol Dial Transplant 2008; 23:3685–3689.
    1. Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr 2008; 87:106–113.
    1. Shoji T, Masakane I, Watanabe Y, et al. Committee of Renal Data Registry JSfDT. Elevated non-high-density lipoprotein cholesterol (non-HDL-C) predicts atherosclerotic cardiovascular events in hemodialysis patients. Clin J Am Soc Nephrol 2011; 6:1112–1120.
    1. Liu Y, Coresh J, Eustace JA, et al. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA 2004; 291:451–459.
    1. Suliman ME, Stenvinkel P, Barany P, et al. Hyperhomocysteinemia and its relationship to cardiovascular disease in ESRD: influence of hypoalbuminemia, malnutrition, inflammation, and diabetes mellitus. Am J Kidney Dis 2003; 41 (3 Suppl 1):S89–95.
    1. Nishizawa Y, Shoji T, Kakiya R, et al. Non-high-density lipoprotein cholesterol (non-HDL-C) as a predictor of cardiovascular mortality in patients with end-stage renal disease. Kidney Int Suppl 2003; 84:S117–S120.
    1. Qureshi AR, Alvestrand A, Divino-Filho JC, et al. Inflammation, malnutrition, and cardiac disease as predictors of mortality in hemodialysis patients. J Am Soc Nephrol 2002; 13 Suppl 1:S28–S36.
    1. Leavey SF, Strawderman RL, Jones CA, et al. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 1998; 31:997–1006.
    1. Ganesh SK, Stack AG, Levin NW, et al. Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001; 12:2131–2138.
    1. AIM-HIGH Investigators. The role of niacin in raising high-density lipoprotein cholesterol to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease and optimally treated low-density lipoprotein cholesterol: baseline characteristics of study participants. The Atherothrombosis Intervention in Metabolic syndrome with low HDL/high triglycerides: impact on Global Health outcomes (AIM-HIGH) trial. Am Heart J 2011; 161:538–543.
    1. Keech A, Simes RJ, Barter P, et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366:1849–1861.

Source: PubMed

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