Background Chronic kidney disease is associated with structural and compositional abnormalities in high-density lipoprotein particles (HDLp). We examined associations of HDLp size, particle subfractions, and apolipoprotein C-III content with incident cardiovascular disease (CVD) events across categories of estimated glomerular filtration rate (eGFR). Methods and Results Analyses included 6699 participants in MESA (Multi-Ethnic Study of Atherosclerosis) with measurements of HDLp and 5723 participants with measurements of HDL apolipoprotein C-III. Cox-regression methods were used to evaluate associations between HDLp and apolipoproteins with CVD events. Larger HDLp size was associated with lower CVD risk in participants with lower eGFR: hazard ratio (95% CI) per SD higher mean HDL size was 1.00 (0.90-1.11) in eGFR ≥60 mL/min per 1.73 m2, 0.65 (0.48-0.86) in eGFR 45 to 59 mL/min per 1.73 m2, and 0.48 (0.25-0.93) in eGFR <45 mL/min per 1.73 m2 (P for interaction=0.05). Associations of HDLp subfractions with CVD varied significantly by eGFR (P for interaction=0.04), with significant inverse associations between higher concentrations of large HDLp and CVD events across categories of kidney function, but nonsignificant results for small HDLp. Only HDLp without apolipoprotein C-III was associated with lower risk of CVD events, with seemingly (albeit not statistically significant) stronger associations among participants with lower eGFR (P for interaction=0.19). Conclusions HDL particles of larger size and higher concentrations of large HDL and of HDL without apolipoprotein C-III were associated with lower CVD risk, with risk estimates seemingly stronger among participants with lower eGFR. Future larger studies are needed to corroborate these findings.

译文

背景: 慢性肾脏疾病与高密度脂蛋白颗粒 (HDLp) 的结构和组成异常有关。我们检查了HDLp大小,颗粒亚组分和载脂蛋白C-III含量与估计肾小球滤过率 (eGFR) 类别的心血管疾病 (CVD) 事件的相关性。方法和结果分析包括在MESA (多种族动脉粥样硬化研究) 中测量HDLp的6699名参与者和在HDL载脂蛋白c-iii测量的5723名参与者。Cox回归方法用于评估HDLp和载脂蛋白与CVD事件之间的关联。在eGFR: 风险比 (95% CI)/SD较低的参与者中,较大的HDLp大小与较低的CVD风险相关。在eGFR ≥ 60 ml/min/1.73平方米中,较高的平均HDL大小为1.00 (0.90-1.11)。0.65 (0.48-0.86) 在eGFR 45至59 ml/min/1.73平方米中,0.48 (0.25-0.93) 在eGFR <45 ml/min/1.73平方米中 (相互作用P = 0.05)。HDLp亚组分与CVD的关联因eGFR而显著变化 (相互作用的P = 0.04),在较高浓度的大HDLp与跨肾功能类别的CVD事件之间存在显著的反向关联,但对于小HDLp则无显著结果。只有没有载脂蛋白c-iii的HDLp与较低的CVD事件风险相关,在eGFR较低的参与者之间似乎 (尽管无统计学意义) 更强的关联 (相互作用P = 0.19)。结论较大尺寸的HDL颗粒和较高浓度的大HDL和没有载脂蛋白c-iii的HDL与较低的CVD风险相关,在eGFR较低的参与者中,风险估计似乎更强。需要未来更大的研究来证实这些发现。

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