High lipoprotein(a) levels and small apolipoprotein(a) size prospectively predict cardiovascular events in dialysis patients

Lipoprotein(a) [Lp(a)] levels are increased in dialysis patients, suggesting that they may play a role in the elevated atherosclerotic cardiovascular disease (ASCVD) risk in this population. Few prospective studies of Lp(a) level, apolipoprotein(a) [apo(a)] size, and ASCVD have been performed in the...

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Published in:Journal of the American Society of Nephrology 2005-06, Vol.16 (6), p.1794-1802
Main Authors: LONGENECKER, J. Craig, KLAG, Michael J, MARCOVINA, Santica M, LIU, Yong-Mei, JAAR, Bernard G, POWE, Neil R, FINK, Nancy E, LEVEY, Andrew S, CORESH, Josef
Format: Article
Language:English
Subjects:
Aged
Atherosclerosis (general aspects, experimental research)
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular Diseases - blood
Cardiovascular Diseases - etiology
Cohort Studies
Female
Humans
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Lipoprotein(a) - blood
Male
Medical sciences
Middle Aged
Nephrology. Urinary tract diseases
Predictive Value of Tests
Prospective Studies
Protein Isoforms - blood
Renal Dialysis - adverse effects
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Summary:Lipoprotein(a) [Lp(a)] levels are increased in dialysis patients, suggesting that they may play a role in the elevated atherosclerotic cardiovascular disease (ASCVD) risk in this population. Few prospective studies of Lp(a) level, apolipoprotein(a) [apo(a)] size, and ASCVD have been performed in the dialysis population. An inception cohort of 833 incident dialysis patients were followed prospectively. Baseline Lp(a) was measured by apo(a) size-independent ELISA and apo(a) size by Western blot after SDS-agarose gel electrophoresis. A combined prospective nonfatal and fatal ASCVD end point included myocardial infarction, coronary revascularization, cerebrovascular accident, carotid endarterectomy, peripheral revascularization, gangrene, or limb amputation. Survival analyses were performed with adjustment for baseline demographics, comorbid conditions, ASCVD risk factors, albumin, lipids, and C-reactive protein. Median follow-up was 27.4 mo, with 297 ASCVD events, 130 non-ASCVD deaths, and seven losses to follow-up over 1649 person-years. In multivariate Cox regression models, both high Lp(a) concentration (>/=53 nmol/L) and low molecular weight (LMW) apo(a) isoforms (123 nmol/L, the relative hazard (RH) of ASCVD was 1.73 (P < 0.0005), compared with high molecular weight apo(a) and Lp(a) level
ISSN:1046-6673
1533-3450
DOI:10.1681/asn.2004110922