Residual Cardiovascular Risk in Chronic Kidney Disease: Role of High-density Lipoprotein

Valentina Kon, Haichun Yang, Sergio Fazio

    Research output: Contribution to journalArticle

    23 Scopus citations

    Abstract

    Although reducing low-density lipoprotein-cholesterol (LDL-C) levels with lipid-lowering agents (statins) decreases cardiovascular disease (CVD) risk, a substantial residual risk (up to 70% of baseline) remains after treatment in most patient populations. High-density lipoprotein (HDL) is a potential contributor to residual risk, and low HDL-cholesterol (HDL-C) is an established risk factor for CVD. However, in contrast to conventional lipid-lowering therapies, recent studies show that pharmacologic increases in HDL-C levels do not bring about clinical benefits. These observations have given rise to the concept of dysfunctional HDL where increases in serum HDL-C may not be beneficial because HDL loss of function is not corrected by or even intensified by the therapy. Chronic kidney disease (CKD) increases CVD risk, and patients whose CKD progresses to end-stage renal disease (ESRD) requiring dialysis are at the highest CVD risk of any patient type studied. The ESRD population is also unique in its lack of significant benefit from standard lipid-lowering interventions. Recent studies indicate that HDL-C levels do not predict CVD in the CKD population. Moreover, CKD profoundly alters metabolism and composition of HDL particles and impairs their protective effects on functions such as cellular cholesterol efflux, endothelial protection, and control of inflammation and oxidation. Thus, CKD-induced perturbations in HDL may contribute to the excess CVD in CKD patients. Understanding the mechanisms of vascular protection in renal disease can present new therapeutic targets for intervention in this population.

    Original languageEnglish (US)
    Pages (from-to)379-391
    Number of pages13
    JournalArchives of Medical Research
    Volume46
    Issue number5
    DOIs
    Publication statusPublished - Jul 1 2015

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    Keywords

    • Cardiovascular disease
    • Cholesterol efflux
    • Chronic kidney disease
    • HDL
    • Residual cardiovascular risk
    • Statins

    ASJC Scopus subject areas

    • Medicine(all)

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