High lipoprotein-associated phospholipase A2 activity is associated with an increased risk for cardiovascular death and major adverse cardiovascular events in patients undergoing maintenance hemodialysis, facilitating the identification of patients at a greater cardiovascular mortality risk, according to the results of a recent prospective cohort study.
Dyslipidemia is a common complication among chronic kidney disease patients undergoing maintenance hemodialysis, and contributes to cardiovascular diseases and associated deaths in these individuals. Various studies suggest the potential role of lipoprotein-associated phospholipase A2 (Lp-PLA2) in predicting the risk of cardiovascular mortality as well as major adverse cardiovascular events (MACEs) among dialyzed patients.
This prospective cohort study aimed to assess the relationship between Lp-PLA2 activity and cardiovascular outcomes for the risk stratification of high-risk patients. The study findings are published in the journal Lipids in Health and Disease.
Baseline Characteristics
The prospective cohort comprised 361 patients on maintenance hemodialysis, with approximately 61.8% males. The median age of study participants was 61 (53–70) years, and the median length of time on dialysis was 35.5 (17.8–76.2) months. The median activity of Lp-PLA2 at the baseline was 481.2 U/L, based on which, the participants were divided into low Lp-PLA2 (n = 181) and high Lp-PLA2 (n = 180) cohorts.
Cardiovascular Outcomes in the Study Cohort
Over the median follow-up period of 78.1 (34.7–104.5) months, deaths occurred in 182 patients died, of which, 42.3% were associated with cardiovascular diseases, including acute coronary syndrome, ischemic stroke, hemorrhagic stroke, heart failure, peripheral artery disease, and cardiac arrest. MACEs occurred in 88 patients in the study cohort. Patients in the high Lp-PLA2 cohort had significantly more MACEs and cardiovascular deaths compared to the low Lp-PLA2 cohort, whereas all-cause mortality was comparable between the two study cohorts.
Prognostic Value of Lp-PLA2 Activity in Cardiovascular Events
The incremental value of the activity of Lp-PLA2 in cardiovascular disease outcomes was appraised using the Net Reclassification Improvement (NRI) index. NRI for MACEs and cardiovascular mortality was significant with the integration of Lp-PLA2 as a continuous variable, approximately 23.97% and 33.32%, respectively.
Study Limitations
In this study, the authors did not record the serial measurement of lipid parameters, including Lp-PLA2, and the administration of a lipid-lowering regimen. The lack of nutritional profile assessment led to the failure to evaluate the role of lipid profile on Lp-PLA2 activity and cardiovascular risks in patients undergoing hemodialysis.
Source:
Lin, L., Teng, J., Shi, Y., Xie, Q., Shen, B., Fei, X., Cao, X., Ding, X., Xu, X., & Zhang, Z. (2024). Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis: a 7-year prospective cohort study. Lipids in Health and Disease, 23(1). https://doi.org/10.1186/s12944-023-01991-0
