Why are lipids not predictive of cardiovascular death in the dialysis patient?

Miner Electrolyte Metab. 1996;22(1-3):9-12.

Abstract

The rate of cardiovascular death, and specifically of cardiac death, in dialysis patient is excessive and comparable to that in the high-risk group of survivors of myocardial infarction. Yet, in patients on dialysis total cholesterol, LDL cholesterol, apolipoprotein B and other indicators of coronary risk--with the exception of lipoprotein(a)--are consistently higher in survivors than in those dying from cardiovascular causes, but at least in diabetic patients on dialysis, an extremely high-risk population, lipids are predictive of cardiac death. Malnutrition as a confounding factor might explain the inverse relation between lipid indicators and cardiac death in nondiabetic patients. Indirect arguments can be marshalled that malnutrition increases cardiac death as a consequence of low L-arginine levels and the ensuing diminished synthesis of NO.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Apolipoproteins B / blood*
  • Arginine / metabolism
  • Arteriosclerosis / epidemiology
  • Arteriosclerosis / mortality
  • Blood Pressure
  • Cardiovascular Diseases / mortality*
  • Cholesterol / blood*
  • Cholesterol, LDL / blood*
  • Diabetes Mellitus, Type 1 / mortality
  • Diabetes Mellitus, Type 1 / physiopathology
  • Diabetes Mellitus, Type 1 / therapy
  • Diabetes Mellitus, Type 2 / mortality
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / therapy
  • Diabetic Nephropathies / mortality
  • Diabetic Nephropathies / physiopathology
  • Diabetic Nephropathies / therapy*
  • Heart Diseases / epidemiology*
  • Heart Diseases / mortality
  • Humans
  • Lipoprotein(a) / blood
  • Nutrition Disorders / etiology
  • Predictive Value of Tests
  • Renal Dialysis*
  • Risk Assessment
  • Survival Rate

Substances

  • Apolipoproteins B
  • Cholesterol, LDL
  • Lipoprotein(a)
  • Arginine
  • Cholesterol