Remnant Cholesterol is Prospectively Associated With Cardiovascular Disease Events and All-Cause Mortality in Kidney Transplant Recipients

P-value comparisons across remnant cholesterol levels are based on Wilcoxon-type tests for trend for categorical variables and Jonckheere–Terpstra tests for continuous variables.

Values are presented as HRs and 95% CIs for the univariate model.

Values presented as HRs and 95% CIs adjusted for age, race, gender, albuminuria, smoking, diabetes, mTOR inhibitors, treatment arm, SBP, BMI, DBP, graft vintage and lipid-lowering drugs (statins) and living versus deceased donor kidney. Each quartile has the number of participants at risk of an event.

Authors and Disclosures

Reuben William Horace^1,2, Mary Roberts², Theresa I. Shireman³, Basma Merhi⁴, Paul Jacques⁵, Andrew G. Bostom⁶, Simin Liu⁷ and Charles B. Eaton<sup>2

1</sup>Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA, ²Center for Primary Care, Prevention, Brown University, Providence, RI, USA, ³Center for Gerontology and Healthcare Research, Brown University School of Public Health, Brown University, Providence, RI, USA, ⁴Department of Medicine, Division of Hypertension and Kidney Diseases, Rhode Island Hospital, Providence, RI, USA, ⁵Nutritional Epidemiology Program, USDA Human Nutrition Research Center on Aging, Medford, MA, USA, ⁶Department of Medicine, Division of Hypertension and Kidney Diseases, Providence, RI, USA and ⁷Departments of Epidemiology and Medicine and Center for Global Cardiometabolic Health, Providence, RI, USA

Correspondence to
Reuben William Horace; E-mail: rhorace@nyit.edu

Conflict of Interest Statement
All of the authors declare that they have no relevant financial interests. The authors whose names are listed as authors on this manuscript certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; participation in speakers' bureaus; membership, employment, consultancies, stock ownership or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interests (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this article.

Sidebar

Key Learning Points

What is Already Known About This Subject?

• Rates of cardiovascular disease (CVD) death in renal transplant recipients (RTRs) remain higher than in the general population, with the rate of CVD death 10 times higher and the annual rate of fatal or nonfatal CVD events 50 times that of the general population.

• To our knowledge, we are the first to demonstrate the relationship among elevated remnant cholesterol levels and the risk of CVD events and all-cause mortality in RTRs.

• Our findings are important, as many kidney transplant recipients (KTRs) receive less-aggressive CVD risk factor management than would be expected given their underlying comorbid burden.

What this study adds?

• In stable KTRs, higher remnant cholesterol level is associated with both CVD events (32% increased risk) and all-cause mortality (31% increased risk). Low-density lipoprotein seems to play an important role in remnant cholesterol and CVD risk.

What impact this may have on practice or policy?

• These prospective observations should be confirmed by large randomized controlled intervention trials in order to determine the clinical impact of remnant cholesterol reduction on CVD and all-cause mortality outcomes in stable KTRs.