 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Yongmei Liu, School of Medicine, Johns Hopkins University, 2024 East Monument Street, Suite 2-516, Baltimore, MD 21205, 410-502-8896, yoliu@jhsph.edu
Background Total cholesterol, a well-established cardiovascular disease (CVD) risk factor in the general population, is inversely associated with mortality in dialysis patients. Systemic inflammation and malnutrition are associated with both lower cholesterol levels and higher mortality. Methods This prospective study of 823 dialysis patients, examines whether the presence of inflammation and malnutrition could explain this inverse association due to confounding or reverse causality. Analyses were stratified by presence of inflammation/malnutrition (defined as serum albumin levels <3.6 mg/dl, C-reactive protein >=10 mg/l, and interleukin-6 >= 3.09 pg/ml). Results 324 deaths (159 CVD deaths), 153 transplantations, and 10 losses to follow-up occurred during a median follow up of 2.4 years. The average levels of serum cholesterol were lower in the presence of inflammation/malnutrition than in the absence of inflammation/malnutrition. In a Cox model adjusted for age, race, gender, and clinic, a 40 mg/dl higher cholesterol level (1.0 mmol/l) was significantly associated with a lower risk of all-cause mortality in the entire cohort (relative hazard [RH]:0.92, 95% confidence interval [CI]:0.9-1.0) and the group with inflammation/malnutrition (RH:0.89; CI: 0.8-1.0), but an increased risk in the group without inflammation/malnutrition (RH:1.32; CI: 1.1-1.6). Further adjustment for traditional CVD risk factors, dialysis modality, serum albumin and inflammatory markers attenuated the inverse association, but strengthened the positive association. Conclusions Systemic inflammation and malnutrition significantly modify the association of total cholesterol with mortality. These findings help alleviate concerns raised about treatment of hypercholesterolemia in this high-risk population.
Learning Objectives:
Keywords: Cholesterol,
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.