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A comprehensive review on apolipoproteins as nontraditional cardiovascular risk factors in end-stage renal disease: current evidence and perspectives

  • Nephrology - Review
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Abstract

Purpose

Nontraditional cardiovascular risk factors such as lipoprotein(a) (Lp(a)), the genetic polymorphisms of apolipoprotein(a), apolipoprotein E (ApoE), and apolipoprotein B (ApoB) increase the prevalence of atherosclerosis in end-stage renal disease (ESRD) through quantitative and qualitative alterations. Given the high burden of cardiovascular fatal events in ESRD, this review aims to gather studies depicting apolipoproteins’ changes in ESRD, to describe current evidence and to explore potential lipid-lowering therapies.

Methods

We searched the electronic database of PubMed, SCOPUS, EBSCO, and Cochrane CENTRAL for studies evaluating apolipoproteins in ESRD. Randomized controlled trials, observational studies (including case–control, prospective, or retrospective cohort), and reviews/meta-analysis were included if reference was made to apolipoproteins and cardiovascular consequences in ESRD.

Results

21 studies met the inclusion criteria. We found a significant correlation between Lp(a) plasma concentrations and atherosclerosis. Lp(a) levels were independent risk factors for atherothrombosis and cardiovascular mortality. LMW apo(a) phenotype proved to be the best predictor for coronary events in ESRD. Single nucleotide polymorphisms in ApoE gene affected the expression and function of the protein, increasing the risk of cardiovascular events. ApoB had a significant correlation with the value of carotid intima–media thickness and vascular stiffness.

Conclusions

The picture of “lipid milieu” in ESRD has not been clearly described. Novel studies show that specific apolipoproteins suffer modifications in uremic patients, being correlated with cardiovascular events. Probably in the next years, the treatment of dyslipidemia in ESRD will not merely target LDL or total cholesterol, but specific isoforms of apolipoproteins which seem to become the central part of the problem.

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Funding

AB: was supported by the Romanian Academy of Medical Sciences and European Regional Development Fund, MySMIS 107124: Funding Contract 2/Axa 1/31.07.2017/107124 SMIS. AC: was supported by a grant of Ministry of Research and Innovation, CNCS—UEFISCDI, project number PN-III-P4-ID-PCE-2016-0908, contract number 167/2017, within PNCDI III.

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Authors and Affiliations

  1. Department of Internal Medicine-Nephrology, “Grigore T. Popa” University of Medicine, Iasi, Romania

    Cristiana Vlad & Andreea Covic

  2. Department of Interventional Cardiology, Cardiovascular Diseases Institute, “Grigore T. Popa” University of Medicine, Iasi, Romania

    Alexandru Burlacu, Bogdan Artene & Carina Ureche

  3. Nephrology Clinic, Dialysis and Renal Transplant Center, ‘C.I. Parhon’ University Hospital, and “Grigore T. Popa” University of Medicine, Iasi, Romania

    Laura Florea, Silvia Badarau & Adrian Covic

  4. Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania

    Dragos Scripcariu

  5. Department of Biochemistry, “Grigore T. Popa” University of Medicine, Iasi, Romania

    Liliana Foia

  6. The Academy of Romanian Scientists (AOSR), Bucharest, Romania

    Adrian Covic

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  1. Cristiana Vlad
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Vlad, C., Burlacu, A., Florea, L. et al. A comprehensive review on apolipoproteins as nontraditional cardiovascular risk factors in end-stage renal disease: current evidence and perspectives. Int Urol Nephrol 51, 1173–1189 (2019). https://doi.org/10.1007/s11255-019-02170-w

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