title: Elevated non-high-density lipoprotein cholesterol (non-HDL-C) predicts atherosclerotic cardiovascular events in hemodialysis patients.
abstract: OBJECTIVE
  Dialysis patients show "reverse causality" between serum cholesterol and mortality. No previous studies clearly separated the risk of incident cardiovascular disease (CVD) and the risk of death or fatality after such events. We tested a hypothesis that dyslipidemia increases the risk of incident atherosclerotic CVD and that protein energy wasting (PEW) increases the risk of fatality after CVD events in hemodialysis patients.
  
  
  METHODS
  This was an observational cohort study in 45,390 hemodialysis patients without previous history of myocardial infarction (MI), cerebral infarction (CI), or cerebral bleeding (CB) at the end of 2003, extracted from a nationwide dialysis registry in Japan. Outcome measures were new onsets of MI, CI, CB, and death in 1 year.
  
  
  RESULTS
  The incidence rates of MI, CI, and CB were 1.43, 2.53, and 1.01 per 100 person-years, and death rates after these events were 0.23, 0.21, and 0.29 per 100 person-years, respectively. By multivariate logistic regression analysis, incident MI was positively associated with non-HDL cholesterol (non-HDL-C) and inversely with HDL cholesterol (HDL-C). Incident CI was positively associated with non-HDL-C, whereas CB was not significantly associated with these lipid parameters. Among the patients who had new MI, CI, and/or CB, death risk was not associated with HDL-C or non-HDL-C, but with higher age, lower body mass index, and higher C-reactive protein levels.
  
  
  CONCLUSIONS
  In this hemodialysis cohort, dyslipidemia was associated with increased risk of incident atherosclerotic CVD, and protein energy wasting/inflammation with increased risk of death after CVD events.
authors.affiliation: Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan. t-shoji@med.osaka-cu.ac.jp
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shoji
authors.forename: Ikuto
authors.initials: I
authors.lastname: Masakane
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000401:mortality*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood*; D015331:Cohort Studies; D050171:Dyslipidemias / Q000097:blood / Q000401:mortality*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000401:mortality; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000401:mortality; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D002097:C-Reactive Protein