The state of lipid metabolism in patients with acute coronary syndrome and chronic kidney disease depending on glomerular filtration rate and smoking factor

Abstract

Aim. To study the features of lipid metabolism disorders in patients with acute coronary syndrome (ACS), depending on glomerular filtration rate (GFR) and smoking factor. Materials and methods. The study included 142 ACS patients (mean age – 59.66 ± 0.78 years). All the patients were divided into two groups according to GFR. Group I comprised 57 individuals with GFR <60 ml/min/1.73 m2; Group II – 85 persons with GFR ≥60 ml/min/1.73 m2. Patients of each group were divided into two subgroups based on smoking status: A – smokers (IA, IIA) and B – non-smokers (IB, IIB). The main serum parameters of lipid metabolism were determined: total cholesterol (TC), low-density lipoprotein cholesterol (LDL cholesterol), high-density lipoprotein cholesterol (HDL cholesterol), triglycerides (TG), non-high-density lipoprotein cholesterol (non-HDL cholesterol). Results. As compared to Group II, Group I have demonstrated significantly higher (by 21–31 %) mean LDL cholesterol (p < 0.01) and non-HDL cholesterol (p < 0.01); higher (by 11–18 %) TC (p < 0.01) and TG (p < 0.05); lower HDL cholesterol (p < 0.05). The results of the subgroup study (based on the smoking status) have shown 22–36 % higher TC, LDL cholesterol, TG, non-HDL cholesterol and 11–16 % lower HDL cholesterol in smokers (IA, IIA) as compared to those in non-smokers (IB, IIB). The study of the smoker subgroups has revealed 13–23 % higher mean TC, LDL cholesterol, and non-HDL cholesterol in Subgroup IA compared to those in Subgroup IIA. The examined patients with lipid profiles different from the reference values were divided into groups. So, up to 18–22 % more individuals with higher LDL cholesterol and lower HDL cholesterol as compared to reference values were in Group I compared to Group II; in the smoker subgroups (IA, IIA), in comparison to non-smoker ones (IB, IIB), there were up to 19–37 % more individuals with higher TC, TG, compared to reference values; in the subgroup of smokers, i.e. in Subgroup IA compared with Subgroup IIA, there were up to 21–24 % more individuals with lower HDL cholesterol and higher non-HDL cholesterol compared with reference values. A correlation analysis has revealed a moderate inverse correlation between TC, LDL cholesterol, non-HDL cholesterol and GFR in Group I and Group II. Moderate and strong inverse correlations between TC, LDL cholesterol, TG, non-HDL cholesterol values and GFR have been found in subgroups of smokers (IA, IIA) and non-smokers (IB, IIB). In addition, in Subgroups IA and IIA, a moderate direct correlation between pro-atherogenic lipid fractions and smoking index has been found. Conclusions. Patients with GFR <60 ml/min/1.73 m2, compared to those with GFR ≥60 ml/min/1.73 m2, have been revealed with significantly higher levels of pro-atherogenic lipid fractions – LDL cholesterol, non-HDL cholesterol – by 21–31 %, TC, TG – by 11–18 %; and lower levels of HDL cholesterol. Regardless of GFR, in each of the two subgroups of smokers (IA, IIA), compared to non-smokers (IB, IIB), there was a significant increase in the levels of TC, LDL cholesterol, TG, non-HDL cholesterol (by up to 11–36 %) and a decrease in HDL cholesterol. The most obvious pro-atherogenic changes in the lipid spectrum were detected in patients with GFR < 60 ml/min/1.73 m2 and smoking factor (IA).

Keywords

• acute coronary syndrome
• chronic kidney disease
• smoking
• glomerular filtration rate
• dyslipidemia