title: Nonesterified fatty acids and cardiovascular mortality in elderly men with CKD.
abstract: OBJECTIVE
  Although nonesterified fatty acids (NEFAs) are essential as energy substrate for the myocardium, an excess of circulating NEFAs can be harmful. This study aimed to assess plausible relationships between serum NEFA and mortality due to cardiovascular disease (CVD) in individuals with CKD.
  
  
  METHODS
  This was a prospective cohort study from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of 1221 elderly men aged 70-71 years residing in Uppsala, Sweden. Data collection took place during 1991-1995. All participants had measures of kidney function; this study investigated 623 (51.7%) of these patients with manifest CKD (defined as either eGFR<60 ml/min per 1.73 m(2) or urine albumin excretion rate ≥20 µg/min). Follow-up for mortality was done from examination date until death or December 31, 2007. After a median follow-up of 14 years (interquartile range, 8-16.8), associations of NEFAs with mortality (related to all causes, CVD, ischemic heart disease [IHD], or acute myocardial infarction) were ascertained.
  
  
  RESULTS
  The median serum NEFA was 14.1 mg/dl (interquartile range, 11.3-17.8). No association was found with measures of kidney function. Diabetes and serum triglycerides were the only multivariate correlates of NEFA. During follow-up, 453 participants died, of which 209 deaths were due to CVD, including 88 IHD deaths, with 41 attributed to acute myocardial infarction (AMI). In fully adjusted covariates, serum NEFA was an independent risk factor for all-cause mortality (hazard ratio [HR] per log2 increase, 1.22; 95% confidence interval [95% CI], 1.00 to 1.48) and CVD-related death (HR, 1.51; 95% CI, 1.15 to 1.99), including both IHD (HR, 1.51; 95% CI, 1.00 to 2.32) and AMI mortality (HR, 2.08; 95% CI, 1.09 to 3.98).
  
  
  CONCLUSIONS
  Elevated serum NEFA associated with CVD mortality, and particularly with mortality due to AMI, in a homogeneous population of older men with moderate CKD.
authors: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China;
authors: Zibo
authors: Z
authors: Xiong
authors: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and.
authors: Hong
authors: H
authors: Xu
authors: Division of Nephrology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China;
authors: Xiaoyan
authors: X
authors: Huang
authors: Molecular Epidemiology, Department of Medical Sciences, and School of Health and Social Studies, Dalarna University, Falun, Sweden.
authors: Johan
authors: J
authors: Ärnlöv
authors: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and.
authors: Abdul Rashid
authors: AR
authors: Qureshi
authors: Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; and.
authors: Tommy
authors: T
authors: Cederholm
authors: Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; and.
authors: Per
authors: P
authors: Sjögren
authors: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and.
authors: Bengt
authors: B
authors: Lindholm
authors: Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; and.
authors: Ulf
authors: U
authors: Risérus
authors: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention, and Technology, and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden; juan.jesus.carrero@ki.se.
authors: Juan Jesús
authors: JJ
authors: Carrero
mesh_terms: D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005230:Fatty Acids, Nonesterified / Q000097:blood*; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D005230:Fatty Acids, Nonesterified; D014280:Triglycerides
keywords: CKD; cardiovascular disease; mortality; nonesterified fatty acid
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