POS-259 MHR status as marker of 10-year risk and lifetime risk of recurrent Cardiovascular events in patients with CKD and Diabetes Mellitus

Abstract

Patients with Chronic kidney disease (CKD) and Diabetes Mellitus are more exposed to atherosclerosis injury and have a higher risk of premature death from cardiovascular disease (CVD). Cardiovascular events are worsened by inflammation, oxidative stress, lipid accumulation and high-density lipoprotein cholesterol (HDL) reduction: individuals with perturbed lipid metabolism more frequently present monocyte profile changes, with an altered pro-inflammatory phenotype leading to a major risk of plaque formation and atherosclerosis. The alteration of the balance between monocyte and HDL, represented by the Monocyte/HDL ratio (MHR), is an easy way to evaluate the inflammatory status and to study appropriate strategies to treat high-risk patients. We evaluated 150 consecutive diabetic patients with CKD hospitalized in the Unit of Nephrology and Dialysis of the Policlinic G. Martino of Messina, Italy, with a history of CVD. We used the SMART-REACH SCORE, a model created to estimate life expectancy without recurrent cardiovascular events for individuals with a history of CVD. We performed a retrospective analysis of the MHR status of our patients to study its correlations with the 10-year risk and lifetime risk for myocardial infarction, stroke or vascular death, recurrent event and free life-expectancy if standard care is provided. In the entire cohort of patients, MHR appeared to be positively correlated with ten-year risk (ρ=0.469; P <0.0001) and lifetime risk of myocardial infarction, stroke, or CV death (ρ=0.428; P <0.0001). Furthermore, patients with higher MHR levels had a significantly smaller number of years of CVD-free life expectancy (ρ=-0.364; P <0.0001) (Figure 1). MHR can represent a valid tool to predict the recurrence of CVD in CKD patients with diabetes. This easy-to-perform marker of oxidative stress and cardiovascular risk can be used alone or in a multiple biomarker approach, improving the stratification and management of patients with comorbidities and risk of life- threatening conditions.