Advanced lipoprotein analysis demonstrates residual atherosclerotic cardiovascular disease risk after remission of nephrotic syndrome

Authors

• M Hwang
• RJ Brown
• L Howard
• M Waldman

Abstract

Background: Nephrotic syndrome (NS) is associated with lipid abnormalities including elevations in total cholesterol, triglycerides, and apolipoproteins. While dyslipidemia improves with remission, unfavorable lipid profiles may persist beyond remission and in those with residual proteinuria. Yet, these changes have not been well characterized. Lipid analysis using nuclear magnetic resonance (NMR) may provide more information about atherosclerotic cardiovascular disease (ASCVD) risk in subjects with active NS vs remission.

Methods: Subjects with paired NMR profiles and standard lipid panels available during active NS and remission (defined by protein excretion >3.5 and <1 g/d, respectively) were included. Measurements included pro-atherogenic triglyceride-rich lipoprotein particles (TRL-P), pro-atherogenic low-density lipoprotein particles (LDL-P) and apoB, anti-atherogenic high-density lipoprotein particles (HDL-P) and apoA1, and GlycA and C-reactive protein (measures of systemic inflammation).

Results: Nineteen subjects with NS were analyzed (68% male, 63% white, mean age 53 years, 68% on lipid lowering drugs). As expected, active NS was associated with an unfavorable lipid profile that improved at remission, including decreases in triglycerides, LDL-C, LDL-P, and apoB. Unexpectedly, TRL-P remained elevated and both HDL-P and apoA1 decreased after remission. GlycA remained elevated at remission despite normal C-reactive protein.

Conclusions: NMR analysis provides a granular snapshot of lipoproteins during contrasting disease states. Despite overall improvement in lipids with remission of NS suggesting decreased atherogenicity, the pattern of decreased apoA1 and HDL-P with persistently high TRL-P may suggest residual ASCVD risk. Lastly, the clinical significance of high GlycA warrants further investigation to understand its value as a ASCVD risk predictor in NS.

Scientific Focus Area: Clinical Research

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