title: Remnant lipoproteinemia predicts cardiovascular events in patients with type 2 diabetes and chronic kidney disease.
abstract: Patients having type 2 diabetes mellitus (DM) and chronic kidney disease (CKD) are at high risk of cardiovascular events. Triglyceride-rich lipoprotein levels are synergistically increased in patients with DM and CKD. This study examined the predictive value of remnant lipoprotein levels for cardiovascular events in patients with DM and CKD.
  
  
  
  Three hundred and sixty-five patients with type 2 DM and CKD were enrolled. Serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) were measured by an immunoseparation method. All patients were followed prospectively for a period of 45±23 months or until occurrence of one of the following events: cardiac death, non-fatal myocardial infarction, unstable angina requiring unplanned coronary revascularization, or ischemic stroke.
  
  
  
  During the follow-up period, 59 patients had cardiovascular events. Multivariate Cox analysis revealed that high levels of RLP-C (≥4.3mg/dL; median value) were a significant risk factor for cardiovascular events, independent of traditional risk factors (HR: 1.30; 95% CI: 1.04-1.63; p=0.02). The addition of high levels of RLP-C to traditional risk factors improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.36, p=0.01; and IDI 0.03, p=0.02).
  
  
  
  RLP-C is useful for risk assessment of future cardiovascular events in patients having type 2 DM and CKD.
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Si Van
authors.initials: SV
authors.lastname: Nguyen
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Uematsu
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujioka
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Jun-Ei
authors.initials: JE
authors.lastname: Obata
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan. Electronic address: kugiyama@yamanashi.ac.jp.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kugiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology*; D002784:Cholesterol / Q000097:blood*; D003643:Death; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D006801:Humans; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D014280:Triglycerides / Q000097:blood*
chemical_list: D008074:Lipoproteins; D014280:Triglycerides; C030087:lipoprotein triglyceride; C112017:remnant-like particle cholesterol; D002784:Cholesterol
keywords: Cardiovascular events; Chronic kidney disease; Diabetes mellitus; Prognosis; Remnant lipoproteins