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Lim TS, Yun JS, Cha SA, Song KH, Yoo KD, Ahn YB, Park YM, Ko SH. Elevated lipoprotein(a) levels predict cardiovascular disease in type 2 diabetes mellitus: a 10-year prospective cohort study. Korean J Intern Med 2016; 31:1110-1119. [PMID: 27756118 PMCID: PMC5094932 DOI: 10.3904/kjim.2016.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/04/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Elevated lipoprotein(a) (Lp[a]) level is known to be a risk factor for cardiovascular disease (CVD). However, the data that has been reported on the association between the Lp(a) level and CVD in type 2 diabetes has been limited and incoherent. The aim of this study was to investigate the relationship between the Lp(a) concentration and new onset CVD in type 2 diabetes. METHODS From March 2003 to December 2004, patients with type 2 diabetes without a prior history of CVD were consecutively enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. Cox proportional hazards models were used to identify the associations between the Lp(a) and CVD after adjusting for confounding variables. RESULTS Of the 1,183 patients who were enrolled, 833 participants were evaluated with a median follow-up time of 11.1 years. A total of 202 participants were diagnosed with CVD (24.2%). The median Lp(a) level for 1st and 4th quartile group was 5.4 (3.5 to 7.1) and 55.7 mg/dL (43.1 to 75.3). Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin and angiotensin converting enzyme inhibitors/angiotensin receptor blockers at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with serum Lp(a) level (hazard ratio, 1.92; 95% confidence interval [CI], 1.26 to 2.92; p < 0.001, comparing the 4th vs. 1st quartile of Lp[a]). CONCLUSIONS Elevated Lp(a) level was an independent predictable risk factor for CVD in type 2 diabetes. Other cardiovascular risk factors should be treated more intensively in type 2 diabetic patients with high Lp(a) levels.
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Affiliation(s)
- Tae-Seok Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Seung Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seon-Ah Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Dong Yoo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu-Bae Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Moon Park
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Seung-Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Seung-Hyun Ko, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: +82-31-249-8174 Fax: +82-31-253-8898 E-mail:
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Yun JS, Ahn YB, Song KH, Yoo KD, Park YM, Kim HW, Ko SH. Lipoprotein(a) predicts a new onset of chronic kidney disease in people with Type 2 diabetes mellitus. Diabet Med 2016. [PMID: 26202453 DOI: 10.1111/dme.12862] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS We investigated the association between lipoprotein(a) [Lp(a)] level and new-onset chronic kidney disease (CKD) in patients with Type 2 diabetes. METHODS We conducted a prospective cohort study from March 2003 to December 2004 with a median follow-up time of 10.1 years. Patients aged 25-75 years with Type 2 diabetes and without CKD [estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73 m(2) ) were consecutively enrolled. The eGFR was measured at least twice every year , and new-onset CKD was defined as a decreased eGFR status of < 60 ml/min/1.73 m(2) using a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. RESULTS Of the 862 patients who were enrolled, 560 (65.0%) completed the follow-up and 125 (22.3%) progressed to CKD. The mean age and duration of diabetes were 53.3 ± 9.6 and 7.5 ± 6.0 years, respectively. The baseline eGFR was 101.8 ± 11.3 ml/min/1.73 m(2) . After adjusting for multiple confounding factors, a Cox hazard regression analysis revealed that the third tertile of Lp(a) was significantly associated with the development of CKD during the observation period when compared with the first tertile [hazard ratio 2.12 (95% confidence interval 1.33-3.36); P = 0.001). CONCLUSIONS In this prospective, longitudinal, observational cohort study, we demonstrated that the Lp(a) level was an independent prognostic factor for the future development of CKD in patients with Type 2 diabetes.
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Affiliation(s)
- J-S Yun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Y-B Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
| | - K-H Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - K-D Yoo
- Division of Cardiology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Y-M Park
- Department of Health and Human Services, Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - H-W Kim
- Division of Nephrology, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S-H Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
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Konishi H, Miyauchi K, Tsuboi S, Ogita M, Naito R, Dohi T, Kasai T, Tamura H, Okazaki S, Isoda K, Daida H. Plasma lipoprotein(a) predicts major cardiovascular events in patients with chronic kidney disease who undergo percutaneous coronary intervention. Int J Cardiol 2015; 205:50-53. [PMID: 26710333 DOI: 10.1016/j.ijcard.2015.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 12/05/2015] [Accepted: 12/12/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with increased risk for cardiovascular disease. The predictive power of traditional risk factors for cardiovascular disease is diminished in patients with CKD. The serum level of lipoprotein(a) [Lp(a)] can be a risk factor for adverse events, but the clinical implications of Lp(a) in patients with CKD who have been treated by percutaneous coronary intervention (PCI) remain uncertain. We aimed to determine the role of Lp(a) on long-term outcomes in patients with CKD after PCI. METHODS We analyzed data from 904 patients with CKD among 3508 patients who underwent a first PCI between 1997 and 2011 at our institution. We divided patients into 2 groups [high (n=454) or low (n=450)] according to median levels of Lp(a). The primary outcome was a composite of all-cause death and acute coronary syndrome (ACS). RESULTS The baseline characteristics of the groups were similar and the median follow-up period was 4.7 years. Cumulative event-free survival was significantly worse for the group with high, than low Lp(a) (P=0.01). Multivariable analysis indicated a high Lp(a) level as an independent predictor of primary outcomes (hazard ratio, 1.35; 95% CI, 1.01-1.82; P=0.04). CONCLUSIONS A high Lp(a) value is associated with a poor prognosis after PCI for patients with CKD.
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Affiliation(s)
- Hirokazu Konishi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Shuta Tsuboi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryo Naito
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Tamura
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
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Rahman M, Yang W, Akkina S, Alper A, Anderson AH, Appel LJ, He J, Raj DS, Schelling J, Strauss L, Teal V, Rader DJ. Relation of serum lipids and lipoproteins with progression of CKD: The CRIC study. Clin J Am Soc Nephrol 2014; 9:1190-8. [PMID: 24832097 DOI: 10.2215/cjn.09320913] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR). RESULTS Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m(2); 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria<0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria>0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories. CONCLUSIONS In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.
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Affiliation(s)
- Mahboob Rahman
- Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio;
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics and
| | - Sanjeev Akkina
- Division of Nephrology, University of Illinois, Chicago, Illinois
| | - Arnold Alper
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | | | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Jiang He
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | - Dominic S Raj
- Division of Nephrology, George Washington University, Washington, DC
| | - Jeffrey Schelling
- Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio; and
| | - Louise Strauss
- University Hospitals Case Medical Center, Cleveland, Ohio
| | - Valerie Teal
- Center for Clinical Epidemiology and Biostatistics and
| | - Daniel J Rader
- Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, Pennsylvania
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Kamstrup PR. Lipoprotein(a) and ischemic heart disease--a causal association? A review. Atherosclerosis 2010; 211:15-23. [PMID: 20106478 DOI: 10.1016/j.atherosclerosis.2009.12.036] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 12/29/2009] [Accepted: 12/31/2009] [Indexed: 01/18/2023]
Abstract
The aim of this review is to summarize present evidence of a causal association of lipoprotein(a) with risk of ischemic heart disease (IHD). Evidence for causality includes reproducible associations of a proposed risk factor with risk of disease in epidemiological studies, evidence from in vitro and animal studies in support of pathophysiological effects of the risk factor, and preferably evidence from randomized clinical trials documenting reduced morbidity in response to interventions targeting the risk factor. Elevated and in particular extreme lipoprotein(a) levels have in prospective studies repeatedly been associated with increased risk of IHD, although results from early studies are inconsistent. Data from in vitro and animal studies implicate lipoprotein(a), consisting of a low density lipoprotein particle covalently bound to the plasminogen-like glycoprotein apolipoprotein(a), in both atherosclerosis and thrombosis, including accumulation of lipoprotein(a) in atherosclerotic plaques and attenuation of t-PA mediated plasminogen activation. No randomized clinical trial of the effect of lowering lipoprotein(a) levels on IHD prevention has ever been conducted. Lacking evidence from randomized clinical trials, genetic studies, such as Mendelian randomization studies, can also support claims of causality. Levels of lipoprotein(a) are primarily determined by variation in the LPA gene coding for the apolipoprotein(a) moiety of lipoprotein(a), and genetic epidemiologic studies have documented association of LPA copy number variants, influencing levels of lipoprotein(a), with risk of IHD. In conclusion, results from epidemiologic, in vitro, animal, and genetic epidemiologic studies support a causal association of lipoprotein(a) with risk of IHD, while results from randomized clinical trials are presently lacking.
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Affiliation(s)
- Pia R Kamstrup
- Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
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Boes E, Coassin S, Kollerits B, Heid IM, Kronenberg F. Genetic-epidemiological evidence on genes associated with HDL cholesterol levels: a systematic in-depth review. Exp Gerontol 2008; 44:136-60. [PMID: 19041386 DOI: 10.1016/j.exger.2008.11.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 10/09/2008] [Accepted: 11/04/2008] [Indexed: 12/12/2022]
Abstract
High-density lipoprotein (HDL) particles exhibit multiple antiatherogenic effects. They are key players in the reverse cholesterol transport which shuttles cholesterol from peripheral cells (e.g. macrophages) to the liver or other tissues. This complex process is thought to represent the basis for the antiatherogenic properties of HDL particles. The amount of cholesterol transported in HDL particles is measured as HDL cholesterol (HDLC) and is inversely correlated with the risk for coronary artery disease: an increase of 1mg/dL of HDLC levels is associated with a 2% and 3% decrease of the risk for coronary artery disease in men and women, respectively. Genetically determined conditions with high HDLC levels (e.g. familial hyperalphalipoproteinemia) often coexist with longevity, and higher HDLC levels were found among healthy elderly individuals. HDLC levels are under considerable genetic control with heritability estimates of up to 80%. The identification and characterization of genetic variants associated with HDLC concentrations can provide new insights into the background of longevity. This review provides an extended overview on the current genetic-epidemiological evidence from association studies on genes involved in HDLC metabolism. It provides a path through the jungle of association studies which are sometimes confusing due to the varying and sometimes erroneous names of genetic variants, positions and directions of associations. Furthermore, it reviews the recent findings from genome-wide association studies which have identified new genes influencing HDLC levels. The yet identified genes together explain only a small amount of less than 10% of the HDLC variance, which leaves an enormous room for further yet to be identified genetic variants. This might be accomplished by large population-based genome-wide meta-analyses and by deep-sequencing approaches on the identified genes. The resulting findings will probably result in a re-drawing and extension of the involved metabolic pathways of HDLC metabolism.
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Affiliation(s)
- Eva Boes
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
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Kwan BCH, Kronenberg F, Beddhu S, Cheung AK. Lipoprotein Metabolism and Lipid Management in Chronic Kidney Disease. J Am Soc Nephrol 2007; 18:1246-61. [PMID: 17360943 DOI: 10.1681/asn.2006091006] [Citation(s) in RCA: 274] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Bonnie C H Kwan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Meadows J, Danik JS, Albert MA. Primary Prevention of Ischemic Heart Disease. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kollerits B, Auinger M, Reisig V, Kästenbauer T, Lingenhel A, Irsigler K, Prager R, Kronenberg F. Lipoprotein(a) as a predictor of cardiovascular disease in a prospectively followed cohort of patients with type 1 diabetes. Diabetes Care 2006; 29:1661-3. [PMID: 16801597 DOI: 10.2337/dc06-0546] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Barbara Kollerits
- Division of Genetic Epidemiology, Innsbruck Medical University, Schöpfstr. 41, A-6020, Innsbruck, Austria
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Schwaiger JP, Lamina C, Neyer U, König P, Kathrein H, Sturm W, Lhotta K, Gröchenig E, Dieplinger H, Kronenberg F. Carotid Plaques and Their Predictive Value for Cardiovascular Disease and All-Cause Mortality in Hemodialysis Patients Considering Renal Transplantation: A Decade Follow-Up. Am J Kidney Dis 2006; 47:888-97. [PMID: 16632029 DOI: 10.1053/j.ajkd.2006.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Accepted: 01/18/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Carotid plaque formation is very common in dialysis patients. The prognostic value of plaques, both calcified and noncalcified, rarely was investigated prospectively in these patients. By using a carotid plaque score, this study aims to determine the risk for combined cardiovascular disease (CVD) events and all-cause mortality in 165 hemodialysis patients in a long-term follow-up considering phases of renal transplantation. METHODS Baseline carotid ultrasonography was performed in 165 hemodialysis patients to screen for carotid plaques. Patients subsequently were followed up for a period up to 13 years (average, 86 months). Because of biases associated with renal transplantation, 3 methods of multivariate analysis were compared by using Cox proportional hazards regression models. RESULTS Plaques were present in 107 of 165 patients (65%). During the observation period, 50 patients (30%) experienced a combined CVD event, 95 patients (58%) died, and 79 patients (48%) underwent at least 1 renal transplantation. Mean plaque score differed significantly between patients who reached an end point and those who did not (CVD events, 3.1 +/- 2.7 versus 2.0 +/- 2.4; P = 0.01; all-cause mortality, 3.5 +/- 2.6 versus 0.9 +/- 1.3; P < 0.001). Plaque score entered all 3 tested Cox regression models for CVD events and all-cause mortality. The lowest statistical power was associated with censoring at the time of renal transplantation. Not considering transplantation at all neglected a major change in risk. CONCLUSION We identified carotid plaque score and treatment modality as highly significant predictors for CVD events and all-cause mortality.
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Affiliation(s)
- Johannes P Schwaiger
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
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Abstract
Patients with nephrotic syndrome (NS) have one of the most pronounced secondary changes in lipoprotein metabolism known, and the magnitude of the changes correlates with the severity of the disease. These changes are of a quantitative as well as a qualitative nature. All apolipoprotein B (apo B)-containing lipoproteins, such as very-low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), low-density lipoproteins (LDL), and lipoprotein(a) [Lp(a)], are elevated in nephrotic syndrome. High-density lipoproteins (HDL) are reported to be unchanged or reduced. In addition to these quantitative changes, the lipoprotein composition is markedly changed, with a higher ratio of cholesterol to triglycerides in the apo B-containing lipoproteins and an increase in the proportion of cholesterol, cholesterol ester, and phospholipids compared with proteins. Also apolipoproteins show major changes, with an increase in apolipoprotein A-I, A-IV, B, C, and E. Particularly the changes in apo C-II, which is an activator of the enzyme lipoprotein lipase (LPL), and apo C-III, an inhibitor of LPL, with an increase of the C-III to C-II ratio, might contribute to the impaired lipoprotein catabolism in NS. The mechanisms for these changes in lipoprotein metabolism are discussed in this review as far as they are known. Furthermore, the tremendous elevations of Lp(a) in nephrotic syndrome and its primary and secondary causes are reviewed. Primary causes became recently apparent by a significantly higher frequency of low-molecular-weight apo(a) phenotypes in patients compared with controls. The secondary causes were shown by an increase of Lp(a) in all apo(a) isoform groups. Because Lp(a) is an LDL-like particle that is usually included in the measured or calculated LDL cholesterol fraction, the influence of the extremely high Lp(a) levels in NS on the measurement of LDL cholesterol is discussed.
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Affiliation(s)
- Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria.
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