title: Malnutrition-inflammation modifies the relationship of cholesterol with cardiovascular disease.
abstract: 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.
authors.affiliation: 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
authors.forename: Gabriel
authors.initials: G
authors.lastname: Contreras
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Thomas
authors.initials: T
authors.lastname: Erlinger
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Michael
authors.initials: M
authors.lastname: Lipkowitz
authors.forename: Julia A
authors.initials: JA
authors.lastname: Lewis
authors.forename: Otelio S
authors.initials: OS
authors.lastname: Randall
authors.forename: Lee
authors.initials: L
authors.lastname: Hebert
authors.forename: Jackson T
authors.initials: JT
authors.lastname: Wright
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Kendrick
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gassman
authors.forename: George
authors.initials: G
authors.lastname: Bakris
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
mesh_terms: 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
chemical_list: D002784:Cholesterol