ABSTRACT
BACKGROUND: Cardiovascular diseases are the leading cause of morbidity and mortality in hemodialysis patients (HP). The aim of the study was to analyze a series of polymorphisms (known to be associated with increased cardiovascular risk in the general population) in HP, in order to better understand the mechanisms of cardiovascular disease and to find new prevention strategies. METHODS: 102 hemodialysis patients were investigated for polymorphisms associated with increased cardiovascular risk in unselected population (FV Leiden R506Q; FV H1299R; FII G20210A; PAI-1 var 4G/5G; GpIIIA T1565C; FXIII var G/T; ß-FIBRINOGENO var G/A; ACE I/D; AGT var M/T; ATR-1A1166C; APOE T112C; APOE T158C; MTHFR C677T; MTHFR A1298C; CBS 844ins68). RESULTS: No difference was observed in the prevalence of the analysed polymorphisms between HP and Caucasian unselected population, with the exception of FV H1299R, PAI-1 (4G/5G), and Factor XIII V34L, which were significantly higher in HP. However none of the genetic factors analysed was associated in HP with the cardiovascular events (non-fatal and fatal) recorded at the time of recruitment or during the eighteen months -follow up. CONCLUSIONS: In HP, the traditional genetic risk factors for cardiovascular disease are not able to predict acute cardiac events, peripheral vascular events, and cerebral vascular events recorded during a follow up period of eighteen months.
Subject(s)
Cardiovascular Diseases/etiology , Polymorphism, Genetic , Renal Dialysis , Aged , Factor V/genetics , Factor XIII/genetics , Female , Humans , Integrin beta3/genetics , Male , Middle Aged , Prothrombin/geneticsABSTRACT
BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients; the increased risk of cardiovascular disease is due to accelerated atherosclerosis, inflammation and impaired lipoprotein metabolism. We aimed to evaluate lipoprotein-associated phospholipase A2 (Lp-PLA2) and some pro-inflammatory aspects of the lipoprotein profile in dialyzed patients in order to evaluate the relationship with the accelerated atherosclerosis and vascular accidents. METHODS: In 102 dialysis patients and 40 non-uremic controls, we investigated the lipoprotein plasma profile, high sensitivity C-reactive protein (CRP), ceruloplasmin and serum amyloid A protein (SAA), and followed patients for 1 year to analyze the risk of acute cardiovascular events. RESULTS: Total cholesterol, low-density lipoprotein and high-density lipoprotein plasma levels were significantly lower in uremic patients than controls, whereas CRP, SAA, ceruloplasmin, Lp-PLA2 and their ratio with apolipoprotein A1 were significantly higher. Patients with Lp-PLA2 levels >194 nmol/min/ml had more acute cardiovascular events than patients with lower values. CONCLUSION: Our results show that in dialysis subjects: (1) low-density lipoproteins show a more atherogenic phenotype than in the general population; (2) high-density lipoproteins are less anti-inflammatory; (3) Lp-PLA2 could potentially be used to evaluate cardiovascular risk.
