Abstract
BackgroundLower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). However, LDL-C reduction does not decrease all-cause mortality among CAD patients when renal function impairs. The association between low baseline LDL-C (< 1.8 mmol/L) and mortality is unknown among patients with CAD and advanced kidney disease (AKD). The current study aimed to evaluate prognostic value of low baseline LDL-C level for all-cause death in these patients.MethodsIn this observational study, 803 CAD patients complicated with AKD (eGFR < 30 mL/min/1.73 m2) were enrolled between January 2008 to December 2018. Patients were divided into two groups (LDL-C < 1.8 mmol/L, n = 138; LDL-C ≥ 1.8 mmol/L, n = 665). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality.ResultsAmong 803 participants (mean age 67.4 years; 68.5% male), there were 315 incidents of all-cause death during a median follow-up of 2.7 years. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for full 24 confounders (e.g., age, diabetes, heart failure, and dialysis, etc.), multivariate Cox regression analysis revealed that lower LDL-C level (< 1.8 mmol/L) was significantly associated with higher risk of all-cause death (adjusted HR, 1.38; 95% CI, 1.01–1.89).ConclusionsOur data demonstrated that among patients with CAD and AKD, a lower baseline LDL-C level (< 1.8 mmol/L) did not present a higher survival rate but was related to a worse prognosis, suggesting a cautiousness of too low LDL-C levels among patients with CAD and AKD.
Highlights
The efficacy of the low-density lipoprotein cholesterol (LDL-C) reduction can ameliorate the cardiovascular mortality of patients with coronary artery disease (CAD) [1,2,3,4,5,6,7]
< 0.001 a Data are presented as the mean value standard deviation or percentage of participants Abbreviations: LDL-C Low-density lipoprotein cholesterol; ACS Acute coronary syndrome; CHF Congestive heart failure; peripheral arterial disease (PAD) Peripheral arterial disease; estimated glomerular filtration rate (eGFR) Estimated glomerular filtration rate; acute myocardial infarction (AMI) Acute myocardial infarction; percutaneous coronary intervention (PCI) Percutaneous coronary intervention; HDL-C High-density lipoprotein cholesterol; TRIG Triglycerides; WBC White blood cell; pro-BNP Pro-brain natriuretic peptide; ACEI Angiotensin-Converting Enzyme Inhibitors; ARB Angiotensin Receptor Blockers all-cause long-term mortality (HR: 1.38, 95% confidence interval (CI): 1.01– 1.89, p = 0.04). and other five models have similar results
Our results showed that the risk with respect to all-cause mortality was more pronounced among patients with baseline LDL-C level < 1.8 mmol/L
Summary
The efficacy of the low-density lipoprotein cholesterol (LDL-C) reduction can ameliorate the cardiovascular mortality of patients with coronary artery disease (CAD) [1,2,3,4,5,6,7]. For patients with CAD and advanced kidney disease (AKD, defined as an eGFR below 30 mL/min/1.73 m2), ISCHEMIA-CKD study recommended a criterion of optimal medical therapy that LDL-C should be controlled below1.8 mmol/L [8]. For patients with CAD and AKD (eGFR < 30 mL/min/1.73 m2), the association between low baseline LDL-C (< 1.8 mmol/L) and mortality is unknown. The present study aimed to investigate the lower baseline LDL-C value in terms of their prognostic value for all-cause death in patients with CAD and AKD. Lower low-density lipoprotein cholesterol (LDL-C) is significantly associated with improved prognosis in patients with coronary artery disease (CAD). The association between low baseline LDL-C (< 1.8 mmol/L) and mortality is unknown among patients with CAD and advanced kidney disease (AKD). We used Kaplan-Meier methods and Cox regression analyses to assess the association between baseline low LDL-C levels and long-term all-cause mortality
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