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Kidney Week

Abstract: FR-PO267

Association of Low-Density Lipoprotein Cholesterol and Atherosclerotic CVD and Non-Atherosclerotic CVD Hospitalization Rate Across CKD Stages in 2 Million US Veterans

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Soohoo, Melissa, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Marroquin, Maria V., Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Moradi, Hamid, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

A prior study has demonstrated that risk of myocardial infarction decreased with higher low-density lipoprotein cholesterol (LDL) levels across worsening estimated glomerular filtration rate (eGFR) category. It was postulated that this attenuated risk with progressing chronic kidney disease (CKD) may be attributed to competing risk of non-atherosclerotic cardiovascular disease events (ASCVD).

Methods

In 1,969,797 US veterans with a serum LDL between 2004 and 2006, associations between LDL and ASCVD and non-ASCVD hospitalizations were estimated using Poisson models adjusted for demographics, comorbid conditions, smoking status, use of statins and non-statins, body mass index and albumin across eGFR category (CKD stage).

Results

The cohort consists of 5% female, 14% African American, 19% diabetic, 32% statin-users, and 44% current smokers, with a mean patient age of 64±14 years. The median [IQR] of serum LDL level and eGFR were 103[81,128] mg/dL and 75[60,91] mL/min/1.73m2, respectively. Patients with higher LDL (>100 mg/dL) had an incrementally higher risk of ASCVD hospitalization rate across all CKD stages compared to the reference (LDL 70-<100 mg/dL); however, associations attenuated with higher CKD stage. Patients with low LDL (<70 mg/dL) had a higher risk of non-ASCVD hospitalization rate across all CKD stages. Patients with LDL≥190 mg/dL also had a higher non-ASCVD hospitalization risk across all CKD stages, except CKD stage 5. Risk of non-ASCVD hospitalization with higher LDL increased between non-CKD to CKD stage 4.

Conclusion

In US veterans, higher LDL level was associated with both higher ASCVD and non-ASCVD hospitalization rate across all CKD stages.The magnitude of association with high LDL for ASCVD events increased across worsening CKD stage, and decreased for non-ASCVD events. Further studies are need to understand why elevated LDL may be associated with higher risk of non-ASCVD events compared to risk of ASCVD events in chronic kidney disease.

Funding

  • Veterans Affairs Support