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The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome

Background and objectives: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. Materials and Methods: This retrospective cohort study includes H...

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Autores principales: Cohen-Hagai, Keren, Benchetrit, Sydney, Wand, Ori, Grupper, Ayelet, Shashar, Moshe, Solo, Olga, Pereg, David, Zitman-Gal, Tali, Haskiah, Feras, Erez, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385584/
https://www.ncbi.nlm.nih.gov/pubmed/37512123
http://dx.doi.org/10.3390/medicina59071312
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author Cohen-Hagai, Keren
Benchetrit, Sydney
Wand, Ori
Grupper, Ayelet
Shashar, Moshe
Solo, Olga
Pereg, David
Zitman-Gal, Tali
Haskiah, Feras
Erez, Daniel
author_facet Cohen-Hagai, Keren
Benchetrit, Sydney
Wand, Ori
Grupper, Ayelet
Shashar, Moshe
Solo, Olga
Pereg, David
Zitman-Gal, Tali
Haskiah, Feras
Erez, Daniel
author_sort Cohen-Hagai, Keren
collection PubMed
description Background and objectives: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. Materials and Methods: This retrospective cohort study includes HD patients hospitalized due to acute coronary syndrome (ACS) in the period 2015–2020 with lipid profile data during ACS. A control group with preserved kidney function was matched. Risk factors for 30-day and 1-year mortality were assessed. Results: Among 349 patients included in the analysis, 246 were HD-dependent (“HD group”). HD group patients had higher prevalence of diabetes, hypertension, and heart disease than the control group. At ACS hospitalization, lipid profile and chronic statin treatment were comparable between groups. Odds ratios for 30-day mortality in HD vs. control group was 5.2 (95% CI 1.8–15; p = 0.002) and for 1-year, 3.4 (95% CI 1.9–6.1; p <0.001). LDL and LDL < 70 did not change 30-day and 1-year mortality rates in the HD group (p = 0.995, 0.823, respectively). However, survival after ACS in HD patients correlated positively with nutritional parameters such as serum albumin (r = 0.368, p < 0.001) and total cholesterol (r = 0.185, p < 0.001), and inversely with the inflammatory markers C-reactive protein (CRP; r = −0.348, p < 0.001) and neutrophils-to-lymphocytes ratio (NLR; r = −0.181, p = 0.019). Multivariate analysis demonstrated that heart failure was the only significant predictor of 1-year mortality (OR 2.8, p = 0.002). LDL < 70 mg/dL at ACS hospitalization did not predict 1-year mortality in the HD group. Conclusions: Despite comparable lipid profiles and statin treatment before and after ACS hospitalization, mortality rates were significantly higher among HD group. While malnutrition–inflammation markers were associated with survival of dialysis patients after ACS, LDL cholesterol was not. Thus, our study results emphasize that better nutritional status and less inflammation are associated with improved survival among HD patients.
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spelling pubmed-103855842023-07-30 The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome Cohen-Hagai, Keren Benchetrit, Sydney Wand, Ori Grupper, Ayelet Shashar, Moshe Solo, Olga Pereg, David Zitman-Gal, Tali Haskiah, Feras Erez, Daniel Medicina (Kaunas) Article Background and objectives: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. Materials and Methods: This retrospective cohort study includes HD patients hospitalized due to acute coronary syndrome (ACS) in the period 2015–2020 with lipid profile data during ACS. A control group with preserved kidney function was matched. Risk factors for 30-day and 1-year mortality were assessed. Results: Among 349 patients included in the analysis, 246 were HD-dependent (“HD group”). HD group patients had higher prevalence of diabetes, hypertension, and heart disease than the control group. At ACS hospitalization, lipid profile and chronic statin treatment were comparable between groups. Odds ratios for 30-day mortality in HD vs. control group was 5.2 (95% CI 1.8–15; p = 0.002) and for 1-year, 3.4 (95% CI 1.9–6.1; p <0.001). LDL and LDL < 70 did not change 30-day and 1-year mortality rates in the HD group (p = 0.995, 0.823, respectively). However, survival after ACS in HD patients correlated positively with nutritional parameters such as serum albumin (r = 0.368, p < 0.001) and total cholesterol (r = 0.185, p < 0.001), and inversely with the inflammatory markers C-reactive protein (CRP; r = −0.348, p < 0.001) and neutrophils-to-lymphocytes ratio (NLR; r = −0.181, p = 0.019). Multivariate analysis demonstrated that heart failure was the only significant predictor of 1-year mortality (OR 2.8, p = 0.002). LDL < 70 mg/dL at ACS hospitalization did not predict 1-year mortality in the HD group. Conclusions: Despite comparable lipid profiles and statin treatment before and after ACS hospitalization, mortality rates were significantly higher among HD group. While malnutrition–inflammation markers were associated with survival of dialysis patients after ACS, LDL cholesterol was not. Thus, our study results emphasize that better nutritional status and less inflammation are associated with improved survival among HD patients. MDPI 2023-07-15 /pmc/articles/PMC10385584/ /pubmed/37512123 http://dx.doi.org/10.3390/medicina59071312 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Cohen-Hagai, Keren
Benchetrit, Sydney
Wand, Ori
Grupper, Ayelet
Shashar, Moshe
Solo, Olga
Pereg, David
Zitman-Gal, Tali
Haskiah, Feras
Erez, Daniel
The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
title The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
title_full The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
title_fullStr The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
title_full_unstemmed The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
title_short The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
title_sort clinical significance of ldl-cholesterol on the outcomes of hemodialysis patients with acute coronary syndrome
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10385584/
https://www.ncbi.nlm.nih.gov/pubmed/37512123
http://dx.doi.org/10.3390/medicina59071312
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