Dyslipidemia is a strong predictor of myocardial infarction in subjects with chronic kidney disease.
OBJECTIVE
To evaluate dyslipidemia as predictor of myocardial infarction (MI) in subjects with or without chronic kidney disease (CKD).


METHODS
In 142,394 middle-aged Swedes referred for laboratory evaluation, glomerular filtration rates (GFR) were estimated using the Modification of Diet in Renal Disease study equation. CKD was defined as GFR 15-60 mL/min/1.73 m(2). Subjects were stratified into presence or absence of CKD, and lipid measures were related to MI using Cox's proportional hazards regression.


RESULTS
During 12 years of follow-up there were 5,466 MIs. The adjusted hazard ratio for MI for the highest versus the lowest quartile of the apolipoprotein (apo) B/apoA-1 ratio among individuals without CKD was 2.88 (95% confidence interval 2.54-3.26) and for those with CKD 3.35 (2.25-4.91). The corresponding estimates for the total cholesterol/high-density lipoprotein (HDL) cholesterol ratio were 3.13 (2.78-3.52) and 3.54 (2.43-5.17), respectively. Receiver operator characteristics analyses showed an advantage in the prediction of MI for the apoB/apoA-1 ratio as compared to conventional lipids (P < 0.0001).


CONCLUSIONS
The ratio of apoB/apoA-1, the ratio of total cholesterol/HDL cholesterol, and non-HDL cholesterol were all strong predictors of myocardial infarction, both among subjects with and without renal dysfunction, with a possible advantage for the apoB/apoA-1 ratio.
Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden. holzmann@karolinska.se
Martin J
MJ
Holzmann
Ingmar
I
Jungner
Göran
G
Walldius
Torbjörn
T
Ivert
Tobias
T
Nordqvist
Jan
J
Ostergren
Niklas
N
Hammar
D000328:Adult; D001053:Apolipoproteins / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D050171:Dyslipidemias / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors
D001053:Apolipoproteins; D002784:Cholesterol