Remnant lipoproteinemia predicts cardiovascular events in patients with type 2 diabetes and chronic kidney disease

• Published in: Journal of cardiology 2017-03, Vol.69 (3), p.529-535
• Main Authors: Nguyen, Si Van, MD, Nakamura, Takamitsu, MD, PhD, Uematsu, Manabu, MD, PhD, Fujioka, Daisuke, MD, PhD, Watanabe, Kazuhiro, MD, PhD, Watanabe, Yosuke, MD, PhD, Obata, Jun-ei, MD, PhD, Nakamura, Kazuto, MD, PhD, Kugiyama, Kiyotaka, MD, PhD, FJCC
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angina, Unstable - etiology; Cardiovascular; Cardiovascular Diseases - etiology; Cardiovascular events; Cholesterol - blood; Chronic kidney disease; Death; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetic Nephropathies - complications; Female; Humans; Lipoproteins - blood; Male; Myocardial Infarction - etiology; Prognosis; Prospective Studies; Remnant lipoproteins; Renal Insufficiency, Chronic - complications; Risk Factors; Stroke - etiology; Triglycerides - blood
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2016.04.011

Abstract Background 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. Methods 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. Results During the follow-up period, 59 patients had cardiovascular events. Multivariate Cox analysis revealed that high levels of RLP-C (≥4.3 mg/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). Conclusions RLP-C is useful for risk assessment of future cardiovascular events in patients having type 2 DM and CKD.