Purpose

This study aimed to clarify the relationship between serum high-density lipoprotein cholesterol (HDL-C) level and incidence of CV events. Moreover, the relationship stratified by gender was evaluated.

Methods

The study database was derived from a multicenter, prospective, cohort study that included 1520 incident dialysis patients in Aichi Prefecture, Japan. Baseline was defined as the time of dialysis initiation and outcome as incidence of CV event. The enrolled patients were first classified into four quartile groups (Q1, Q2, Q3, and Q4; Q1 was the lowest serum HDL-C) based on serum HDL-C level. A multivariate Cox proportional hazards analysis was conducted using the stepwise regression method to determine factors associated with outcomes and was performed in each gender.

Results

The log-rank test revealed significant differences in the incidence of CV events between not only the four groups (p = 0.003) but also the male and female patients (HR, 0.74; 95% CI, 0.59–0.92; p < 0.001). Stepwise regression analysis indicated that higher serum HDL-C level was significantly associated with lower incidence of CV events (HR, 0.88; 95% CI, 0.82–0.95; p = 0.001). The association between serum HDL-C and incidence of CV events could be clarified in only female patients (male patients; HR, 0.92; 95% CI, 0.84–1.01; p = 0.067 and female patients; HR, 0.81; 95% CI, 0.72–0.92; p = 0.001).

Conclusions

HDL-C level at the initiation of dialysis was associated with the incidence of CV events. Moreover, the association was prominent in female patients.

Trial registration

The trial registration number of the study is UMIN 7096, registered on January 18, 2012.

中文翻译：

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性别差异对事件透析患者血清高密度脂蛋白水平与心血管事件之间关系的影响：一项多中心前瞻性队列研究。

目的

这项研究旨在阐明血清高密度脂蛋白胆固醇（HDL-C）水平与CV事件发生率之间的关系。此外，评估了按性别分层的关系。

方法

该研究数据库源自一项多中心，前瞻性队列研究，该研究包括日本爱知县的1520名透析患者。基线定义为开始透析的时间，结果定义为CV事件的发生率。根据血清HDL-C水平，将入选患者首先分为四个四分位数组（Q1，Q2，Q3和Q4； Q1是最低的血清HDL-C）。使用逐步回归方法进行多变量Cox比例风险分析，以确定与结果相关的因素，并在每种性别中进行。

结果

对数秩检验表明，不仅四组 患者之间的心血管事件发生率存在显着差异（p = 0.003），而且男性和女性患者之间也是如此（HR，0.74； 95％CI，0.59–0.92；p  <0.001）。逐步回归分析表明，较高的血清HDL-C水平与较低的CV事件发生率显着相关（HR，0.88； 95％CI，0.82-0.95；p  = 0.001）。仅女性患者（男性患者； HR，0.92； 95％CI，0.84-1.01；p  = 0.067；女性患者； HR，0.81； 95％CI， 0.72-0.92；p  = 0.001）。

结论

透析开始时的HDL-C水平与CV事件的发生率相关。此外，该关联在女性患者中尤为突出。

试用注册

该研究的试验注册号为UMIN 7096，于2012年1月18日注册。