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Lipoprotein-associated phospholipase A2 predicts cardiovascular events in dialyzed patients

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Abstract

Background

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a serine lipase that enhances the instability of the atherosclerotic plaques. While in the general and cardiac population Lp-PLA2 is recognized as an important determinant of cardiovascular (CV) accidents, no data are available for the renal population. The aim of this study was to evaluate the relationship between Lp-PLA2 and acute CV events in hemodialyzed patients.

Methods

We enrolled 102 dialyzed patients, 63% male, age 71 years (59–78), 35% with diabetes, 54% hypertension, 40% coronary artery disease and 31% peripheral vascular disease. They were investigated for Lp-PLA2 (cut-off < 194 nmol/min/ml), lipoprotein profile and the occurrence of acute CV events and death in the subsequent 3 years of follow-up.

Results

The median (interquartile ranges) levels of Lp-PLA2, total-, HDL-, LDL-cholesterol and ApoB/ApoA lipoprotein ratio were 184.5 (156.5–214.5) nmol/min/ml, 158 (127–191) mg/dl, 41 (33–51) mg/dl, 79 (63–102) mg/dl and 0.72 (0.58–0.89), respectively. In 42% of patients, Lp-PLA2 was > 194 nmol/min/ml and total- and LDL-cholesterol were higher, as well as CV morbidity and mortality. During follow-up, 51% of patients developed at least one CV event; the median survival time was 36 months, with a total and CV mortality of 42 and 29%, respectively. At multivariate Cox regression, Lp-PLA2 > 194 nmol/min/ml (HR = 2.98, p = 0.005), age (HR = 1.03, p = 0.029), diabetes (HR = 2.86, p = 0.002) and hypertension (HR = 2.93, p = 0.002) were independently associated with time to CV events.

Conclusions

Lp-PLA2 activity is elevated among dialyzed patients and is an independent risk factor for acute CV events in a mean follow-up of 3 years.

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Authors and Affiliations

  1. Nephrology and Dialysis Unit, “Maggiore della Carità” University Hospital, Corso Mazzini 18, 28100, Novara, Italy

    Andreana De Mauri & Doriana Chiarinotti

  2. Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy

    Andreana De Mauri, Giorgio Bellomo & Roberta Rolla

  3. Clinical Chemistry Laboratory, “Maggiore della Carità” University Hospital, Novara, Italy

    Matteo Vidali, Giorgio Bellomo & Roberta Rolla

Authors
  1. Andreana De Mauri
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  2. Matteo Vidali
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  3. Doriana Chiarinotti
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  4. Giorgio Bellomo
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  5. Roberta Rolla
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Contributions

All authors participated in the study design, in the collection, analysis, and interpretation of data, in the writing or reviewing the manuscript; they also agree to submit the manuscript in the present form.

Corresponding author

Correspondence to Andreana De Mauri.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical Committee of our Institution and was in accordance with Helsinki Declaration. Personal and clinical data were collected in a database in an anonymous form.

Informed consent

As approved by the institutional review board for human subjects, the residual plasma used in this study was considered discarded and no informed consent was necessary. In addition, as stated for retrospective studies, formal consent is not required.

Additional information

Dr. Matteo Vidali is to be considered as co-first author.

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De Mauri, A., Vidali, M., Chiarinotti, D. et al. Lipoprotein-associated phospholipase A2 predicts cardiovascular events in dialyzed patients. J Nephrol 32, 283–288 (2019). https://doi.org/10.1007/s40620-018-0521-3

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  • DOI: https://doi.org/10.1007/s40620-018-0521-3

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