Abstract P351: Remnant Cholesterol and Cardiovascular Disease Outcomes in Chronic Kidney Transplant Recipients

Abstract

Remnant cholesterol (RC) is the cholesterol content of circulating triglyceride-rich lipoproteins. Studies employing a simple calculation of RC from routine lipid/lipoprotein measures have demonstrated associations between RC levels and cardiovascular disease (CVD) outcomes in both observational study, and lipid lowering clinical trial cohorts. There are no published data evaluating the potential relationship between remnant cholesterol and CVD in chronic kidney transplant recipients [KTRs], a population with excess risk for fatal and non-fatal CVD. RC was calculated, using non-fasting plasma samples, as total cholesterol - [HDL cholesterol + LDL cholesterol] in n=3002 FAVORIT trial [NCT00064753] participants at randomization (mean 37.6, standard deviation ± 21.3, range 4-230 mg/dl). During a median follow-up of 4.0-years, the cohort experienced n=419 CVD outcomes [myocardial infarction, stroke, resuscitated sudden death, CVD death, and CVD procedural events, pooled]. Multivariable logistic regression modeling revealed that each 10 mg/dl increase of RC conferred a 16.4% increase [95% CI, 3.6-30.8%] in CVD risk adjusted for age, baseline CVD, diabetes, smoking, race, sex, body-mass index, LDL, HDL, natural log triglycerides, estimated glomerular filtration rate, natural log urinary albumin/creatinine, type of kidney graft, graft vintage, and the use of calcineurin inhibitors, steroids, or lipid lowering drugs. Given the residual risk for CVD after recommended LDL levels are achieved, these data suggest that interventions [i.e., such as eicosapentaenoic acid ethyl ester, which can lower RC by ~25-30%; Atherosclerosis 2016; 253: 81-87] targeting elevated RC concentrations in KTRs, merit consideration.