Effect Of Renal Dysfunction On HDL Particle Size In Patients With Coronary Heart Disease

BackgroundDyslipidemia is recognized as an independent risk factor of coronary heart disease.HDL is generally considered to be a protective factor for cardiovascular diseases and events,however,several clinical trials meant to raise HDL-C level had failed to achieve an ideal result to reduce cardiovascular occurrence and mortality subsequently,thus there has been a growing attention on HDL particles and HDL function.However,to this date the opinions on the relationship between HDL particles and cardiovascular diseases remain inconsistent.Many studies have proven an intimate relationship between chronic kidney disease and dyslipidemia:on one hand,dyslipidemia takes part in accelatating the loss of renal function while on the other hand renal dysfunction may also affect lipid metabolism.Yet the potential effect of renal dysfunction has on lipopretein particles have not been fully explored,especially on HDL particles.Researchers have proved that the ratio between HDL-C and apolipoprotein is in linear correlation with HDL particle diameters measured by NMR and can serve as a reliable representor of actual HDL particle sizes.Therefore,our research intends to explore potential effect of kidney function on HDL particle sizes and clinical value in patients with coronary heart disease.MethodsOur study is a retrospective research conducted in two parts:the effect of kidney function on HDL particle sizes in patients with coronary heart disease,and the relationship between HDL particle sizes and the severity and occurrence of coronary heart disease.494 patients were included in our study,and all of them were hospitalized in Nanfang hospital between January 2013 and December 2018 and underwent coronary angiography for this first time.387 of them were diagnosed as coronary heart disease.Their baseline characteristics,creatine,lipid profiles and coronary angiography results were collected and HDL-C/apoA-I,eGFR and Gensini score were calculated.HDL-C/apoA-I was then compared between groups stratified by eGFR and Gensini scores,and the association between HDL particle size and the occurrence of coronary heart disease was explored.ResultsPart 1:The effect of kidney function on HDL particle sizes in patients with coronary heart diseaseHDL particle sizes decresed significantly in patients with coronary heart disease,comparing with non-coronary heart disease subjects(P<0.001).But when analysed in coronary heart patients alone,HDL particle grew apparently larger as eGFR declined,and a statistically significance appeared when eGFR dropped to 60ml/min·1.73m2(P=0.03).Part 2:The relationship between HDL particle sizes and the severity and occurence of coronary heart disease1.In patients with more severe coronary artery stenosis,HDL particle sizes showed atendency of decreasing,but with no statically significance(P=0.891).Thus same method was applied in all enrolled subjects and coronary heart disease patients without kidney deficiency and in both group HDL particles grew significantly larger with lower Gensini scores.(P=0.038 and P=0.017)2.Regardless of renal function,larger HDL particles were associated with a lower risk for coronary heart disease(OR 0.348 and OR 0.339 respectively,P<0.001)Conclusion1.HDL particle sizes in coronary heart disease were affected by renal function.Started from an eGFR of 60 ml/min·1.73m2,HDL particles grew significantly larger as eGFR declined.2.In coronary heart disease patients with normal renal function,smaller HDL particles were associated with more severe choronary artery stenosis,but the association was lost in coronary heart disease patients with renal deficiency.3.Regardless of renal function,larger HDL particles were associated with a lower risk for coronary heart disease4.The size and clinical value of HDL particles were altered in the presence of kidney deficiency in patients with coronary heart disease.