Abstract

WIKINSKI, Regina et al. Reverse epidemiology: low concentration of modified LDL and cardiovascular morbidity and mortality in hemodialysis patients. Acta bioquím. clín. latinoam. [online]. 2013, vol.47, n.1, pp.95-100. ISSN 0325-2957.

The decrease in LDL cholesterol (LDL-C) is considered the main goal in the treatment of patients with atherosclerotic cardiovascular risk. However, patients with chronic kidney disease (CKD) on hemodialysis have LDL-C below 100 mg/dL, moderate increases in triglycerides and low frequency of HDL cholesterol values below desirable.This condition fits into the phenomenon known as "reverse epidemiology", in which the normal relationship between hypercholesterolemia, high blood pressure, obesity and cardiovascular morbidity and mortality is not found; contrarily, there is a reversal in the close relationship of these parameters with cardiovascular events typical of non-hemodialyzed patients. On the one hand, 35% of CKD patients have Type 2 diabetes mellitus and on the other hand, there are other lesser known pathogenic factors such as lipoprotein-associated phospholipase A2, C-reactive protein, remnant lipoproteins, Lp(a) and enzymes and proteins associated to HDL such as paraoxonase and Apo A-I. The set of factors described could replace, in CKD patients on hemodialysis, LDL cholesterol, a typical analyte that, in other patients, acts as a risk and/or pathogenesis factor of atherosclerosis and not only as a circulating marker. A likely explanation for decreased C-LDL cholesterol is qualitative modification of LDL as a result of oxidation, glycation, carbamylation, occurrence of small and dense LDL, inflammatory phenomena and malnutrition.

Keywords : Reverse epidemiology; Hemodialysis; Cardiovascular risk; LDL cholesterol; Lipoprotein-associated phospholipase A2; Inflammation; Remnant lipoproteins; Lp(a).

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