Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease.
In moderate and severe CKD, the association of cholesterol with subsequent cardiovascular disease (CVD) is weak. We examined whether malnutrition or inflammation (M-I) modifies the risk relationship between cholesterol levels and CVD events in African Americans with hypertensive CKD and a GFR between 20 and 65 ml/min per 1.73 m². We stratified 990 participants by the presence or absence of M-I, defined as body mass index <23 kg/m² or C-reactive protein >10 mg/L at baseline. The primary composite outcome included cardiovascular death or first hospitalization for coronary artery disease, stroke, or congestive heart failure occurring during a median follow-up of 77 months. Baseline total cholesterol (212 ± 48 versus 212 ± 44 mg/dl) and overall incidence of the primary CVD outcome (19 versus 21%) were similar in participants with (n = 304) and without (n = 686) M-I. In adjusted analyses, the CVD composite outcome exhibited a significantly stronger relationship with total cholesterol for participants without M-I than for participants with M-I at baseline (P < 0.02). In the non-M-I group, the cholesterol-adjusted hazard ratio (HR) for CVD increased progressively across cholesterol levels: HR = 1.19 [95% CI; 0.77, 1.84] and 2.18 [1.43, 3.33] in participants with cholesterol 200 to 239 and ≥240 mg/dl, respectively (reference: cholesterol <200). In the M-I group, the corresponding HRs did not vary significantly by cholesterol level. In conclusion, the presence of M-I modifies the risk relationship between cholesterol level and CVD in African Americans with hypertensive CKD.
Contreras
Gabriel
G
Department of Medicine, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 360E, Miami, FL 33136, USA. gcontrer@med.miami.edu
Hu
Bo
B
Astor
Brad C
BC
Greene
Tom
T
Erlinger
Thomas
T
Kusek
John W
JW
Lipkowitz
Michael
M
Lewis
Julia A
JA
Randall
Otelio S
OS
Hebert
Lee
L
Wright
Jackson T
JT
Kendrick
Cynthia A
CA
Gassman
Jennifer
J
Bakris
George
G
Kopple
Joel D
JD
Appel
Lawrence J
LJ
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D015984:Causality; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D007249:Inflammation / Q000175:diagnosis / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis
D002784:Cholesterol