Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans
Background High triglycerides are associated with atherosclerotic cardiovascular disease (ASCVD) risks. Among patients with advanced chronic kidney disease (CKD), the association of elevated triglycerides with mortality is diminished and, thus, we investigated the relationship of triglycerides with...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.022988 |
| _version_ | 1797942653578379264 |
|---|---|
| author | Melissa Soohoo Leila Hashemi Jui‐Ting Hsiung Hamid Moradi Matthew J. Budoff Csaba P. Kovesdy Kamyar Kalantar‐Zadeh Elani Streja |
| author_facet | Melissa Soohoo Leila Hashemi Jui‐Ting Hsiung Hamid Moradi Matthew J. Budoff Csaba P. Kovesdy Kamyar Kalantar‐Zadeh Elani Streja |
| author_sort | Melissa Soohoo |
| collection | DOAJ |
| description | Background High triglycerides are associated with atherosclerotic cardiovascular disease (ASCVD) risks. Among patients with advanced chronic kidney disease (CKD), the association of elevated triglycerides with mortality is diminished and, thus, we investigated the relationship of triglycerides with ASCVD and non‐ASCVD hospitalizations across CKD stages. Methods and Results The cohort comprised 2 963 176 veterans who received care in 2004 to 2006 (baseline) and were followed up to 2014. Using Cox models, we evaluated baseline and time‐varying triglycerides with time to ASCVD or non‐ASCVD hospitalizations, stratified by baseline CKD stage, and adjusted for demographics and baseline or time‐updated clinical characteristics. The cohort mean±SD age was 63±14 years, with a baseline median (interquartile range) triglycerides level of 127 (87–189) mg/dL, and a quarter had prevalent CKD. There was a linear association between baseline triglycerides and ASCVD risk; however, the risk with high triglycerides ≥240 mg/dL attenuated with worsening CKD stages (reference: triglycerides 120 to <160 mg/dL). Baseline triglycerides were associated with a U‐shaped relationship for non‐ASCVD events in patients with CKD 3A to 3B. Patients with late‐stage CKD had lower to null relationships between baseline triglycerides and non‐ASCVD events. Time‐varying triglycerides associations with ASCVD were similar to baseline analyses. Yet, the time‐varying triglycerides relationship with non‐ASCVD events was inverse and linear, where elevated triglycerides were associated with lower risks. Conclusions Associations of higher triglycerides with ASCVD and non‐ASCVD events declined across advancing CKD stages, where a lower to null risk was observed in patients with advanced CKD. Studies are needed to examine the impact of advanced CKD on triglycerides metabolism and its association with outcomes in this high‐risk population. |
| first_indexed | 2024-04-10T20:12:01Z |
| format | Article |
| id | doaj.art-1a5dddf307e947ff8843ffb381985d43 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T20:12:01Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1a5dddf307e947ff8843ffb381985d432023-01-26T10:36:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-12-01102310.1161/JAHA.121.022988Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US VeteransMelissa Soohoo0Leila Hashemi1Jui‐Ting Hsiung2Hamid Moradi3Matthew J. Budoff4Csaba P. Kovesdy5Kamyar Kalantar‐Zadeh6Elani Streja7Division of Nephrology and Hypertension Harold Simmons Center for Kidney Disease Research and Epidemiology University of California Irvine Medical Center Orange CADepartment of General Internal Medicine Greater Los Angeles Healthcare System Los Angeles CADivision of Nephrology and Hypertension Harold Simmons Center for Kidney Disease Research and Epidemiology University of California Irvine Medical Center Orange CADivision of Nephrology and Hypertension Harold Simmons Center for Kidney Disease Research and Epidemiology University of California Irvine Medical Center Orange CADivision of Cardiology The Lundquist Institute for Biomedical Innovation at Harbor‐UCLA Medical Center Torrance CANephrology Section Memphis Veterans Affairs Medical Center Memphis TNDivision of Nephrology and Hypertension Harold Simmons Center for Kidney Disease Research and Epidemiology University of California Irvine Medical Center Orange CADivision of Nephrology and Hypertension Harold Simmons Center for Kidney Disease Research and Epidemiology University of California Irvine Medical Center Orange CABackground High triglycerides are associated with atherosclerotic cardiovascular disease (ASCVD) risks. Among patients with advanced chronic kidney disease (CKD), the association of elevated triglycerides with mortality is diminished and, thus, we investigated the relationship of triglycerides with ASCVD and non‐ASCVD hospitalizations across CKD stages. Methods and Results The cohort comprised 2 963 176 veterans who received care in 2004 to 2006 (baseline) and were followed up to 2014. Using Cox models, we evaluated baseline and time‐varying triglycerides with time to ASCVD or non‐ASCVD hospitalizations, stratified by baseline CKD stage, and adjusted for demographics and baseline or time‐updated clinical characteristics. The cohort mean±SD age was 63±14 years, with a baseline median (interquartile range) triglycerides level of 127 (87–189) mg/dL, and a quarter had prevalent CKD. There was a linear association between baseline triglycerides and ASCVD risk; however, the risk with high triglycerides ≥240 mg/dL attenuated with worsening CKD stages (reference: triglycerides 120 to <160 mg/dL). Baseline triglycerides were associated with a U‐shaped relationship for non‐ASCVD events in patients with CKD 3A to 3B. Patients with late‐stage CKD had lower to null relationships between baseline triglycerides and non‐ASCVD events. Time‐varying triglycerides associations with ASCVD were similar to baseline analyses. Yet, the time‐varying triglycerides relationship with non‐ASCVD events was inverse and linear, where elevated triglycerides were associated with lower risks. Conclusions Associations of higher triglycerides with ASCVD and non‐ASCVD events declined across advancing CKD stages, where a lower to null risk was observed in patients with advanced CKD. Studies are needed to examine the impact of advanced CKD on triglycerides metabolism and its association with outcomes in this high‐risk population.https://www.ahajournals.org/doi/10.1161/JAHA.121.022988atherosclerosisstatisticstriglycerides |
| spellingShingle | Melissa Soohoo Leila Hashemi Jui‐Ting Hsiung Hamid Moradi Matthew J. Budoff Csaba P. Kovesdy Kamyar Kalantar‐Zadeh Elani Streja Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atherosclerosis statistics triglycerides |
| title | Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans |
| title_full | Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans |
| title_fullStr | Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans |
| title_full_unstemmed | Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans |
| title_short | Risk of Atherosclerotic Cardiovascular Disease and Nonatherosclerotic Cardiovascular Disease Hospitalizations for Triglycerides Across Chronic Kidney Disease Stages Among 2.9 Million US Veterans |
| title_sort | risk of atherosclerotic cardiovascular disease and nonatherosclerotic cardiovascular disease hospitalizations for triglycerides across chronic kidney disease stages among 2 9 million us veterans |
| topic | atherosclerosis statistics triglycerides |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.022988 |
| work_keys_str_mv | AT melissasoohoo riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT leilahashemi riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT juitinghsiung riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT hamidmoradi riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT matthewjbudoff riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT csabapkovesdy riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT kamyarkalantarzadeh riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans AT elanistreja riskofatheroscleroticcardiovasculardiseaseandnonatheroscleroticcardiovasculardiseasehospitalizationsfortriglyceridesacrosschronickidneydiseasestagesamong29millionusveterans |