Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis: a 7-year prospective cohort study

• Published in: Lipids in health and disease Vol. 23; no. 1; pp. 15 - 18
• Main Authors: Lin, Lin, Teng, Jie, Shi, Yiqin, Xie, Qiwen, Shen, Bo, Xiang, Fangfang, Cao, Xuesen, Ding, Xiaoqiang, Xu, Xialian, Zhang, Zhen
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.01.2024; BioMed Central; BMC
• Subjects: 1-Alkyl-2-acetylglycerophosphocholine Esterase; Acute coronary syndromes; Apolipoprotein B; Atherosclerosis; Biomarkers; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular Diseases; Care and treatment; Cholesterol; Cholesterol, LDL; Chronic kidney failure; Comorbidity; Complications and side effects; Death; Diabetes; Dyslipidemia; Health aspects; Heart failure; Hemodialysis; Hemodialysis patients; High density lipoprotein; Humans; Inflammation; Kidney diseases; Kidney transplants; Lipids; Lipoprotein-associated phospholipase A2; Lipoproteins; Low density lipoprotein; Medical imaging; Metabolic disorders; Mortality; Patient outcomes; Patients; Peritoneal dialysis; Phospholipase; Phospholipase A2; Phospholipases; Physiological aspects; Population; Population studies; Prognosis; Prospective Studies; Reclassification; Renal Dialysis; Risk Factors; Statins; Stroke; Variables; China; Cardiovascular disease; Lipoprotein-associated phospholipase A2; Hemodialysis; Dyslipidemia
• DOI: 10.1186/s12944-023-01991-0
• ISSN: 1476-511X

Cardiovascular diseases (CVD) is the leading cause of death among maintenance hemodialysis patients, with dyslipidemia being a prevalent complication. The paradoxical relationship between cardiovascular outcomes and established lipid risk markers, such as low-density lipoprotein cholesterol (LDL-C), complicates lipid management in this population. This study investigated Lipoprotein-associated phospholipase A2 (Lp-PLA2), an emerging biomarker known for its proinflammatory and proatherogenic properties, as a potential cardiovascular prognostic marker in this cohort. In this context, the association between Lp-PLA2 levels and cardiovascular outcomes was evaluated, with the aim to facilitate more accurate stratification and identification of high-risk individuals. From August 2013 to January 2014, 361 hemodialysis patients were prospectively enrolled. Lp-PLA activity and laboratory measures at baseline were quantified. Comorbidities and medications were recorded. All patients were followed until the end of April, 2022. The individual and combined effects of Lp-PLA activity and LDL-C on patient outcomes were examined. The association between Lp-PLA activity and all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) was analyzed. The median Lp-PLA activity was 481.2 U/L. In subjects with Lp-PLA activity over 481.2 U/L, significantly higher total cholesterol (4.89 vs. 3.98 mmol/L; P < 0.001), LDL-C (3.06 vs. 2.22 mmol/L; P < 0.001), and apolipoprotein B (0.95 vs. 0.75 mmol/L; P < 0.001) were observed. Over a median follow-up of 78.1 months, 182 patients died, with 77 cases identified as cardiovascular death, 88 MACEs happened. Cardiovascular mortality and MACEs, but not all-cause mortality, were significantly increased in the high Lp-PLA2 group. Cox regression analyses showed that high Lp-PLA activity was associated with cardiovascular mortality and MACE occurrence. After comprehensive adjustment, high Lp-PLA activity was independently associated with cardiovascular mortality(as a dichotomous variable: HR:2.57, 95%CI:1.58,4.18, P < 0.001; as a continuous variable: HR:1.25, 95%CI:1.10,1.41, P = 0.001) and MACEs(as a dichotomous variable: HR:2.17, 95%CI:1.39,3.40, P = 0.001; as a continuous variable: HR:1.20, 95%CI:1.07,1.36, P = 0.002). When participants were grouped by median Lp-PLA2 activity and LDL-C values, those with high Lp-PLA and low LDL-C had the highest CV mortality. The addition of Lp-PLA2 significantly improved reclassification (as a dichotomous variable NRI = 42.51%, 95%CI: 5.0%,61.33%; as a continuous variable, NRI = 33.32%, 95% CI: 7.47%,56.21%). High Lp-PLA activity is an independent risk factor for cardiovascular mortality and MACEs occurrence in patients on hemodialysis. The combined measures of Lp-PLA and LDL-C help to identify individuals with a higher risk of cardiovascular death.