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Zhang J, Song X, Li Z, Xu H, Shu H, Li J, Zhang Y. Association of apolipoprotein levels with all-cause and cardiovascular mortality. Eur J Prev Cardiol 2024; 31:1183-1194. [PMID: 38417834 DOI: 10.1093/eurjpc/zwae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
AIMS Research has shown that apolipoproteins (Apos) are potential indicators of heart health and death. We investigated the associations of Apo levels with all-cause and cardiovascular mortality. METHODS AND RESULTS We systematically searched the Cochrane Library, PubMed, and Web of Science for English language studies up to 28 November 2022. We used Stata 17.0 to summarize the estimated effects with 95% confidence intervals (CIs). We also conducted subgroup analyses according to study location, year of publication, individual age, follow-up years, and sample size. Moreover, we performed a sensitivity analysis to evaluate bias in our study. This study included 23 studies with 152 854 individuals in total. The level of ApoA was negatively related to cardiovascular mortality [odds ratio (OR) = 0.69, 95% CI = 0.52-0.93]. An increased ratio of ApoB/A1 was a risk factor for cardiovascular mortality (OR = 2.13, 95% CI = 1.48-3.07) and all-cause mortality (OR = 2.05, 95% CI = 1.52-2.77). The level of ApoB was positively related to cardiovascular mortality (OR = 1.12, 95% CI = 0.85-1.47), but the difference was not statistically significant. However, the associations between ApoB or ApoA1 and all-cause mortality were not obvious. Our subgroup analyses showed that the location, year of publication, individual age, and follow-up years of the studies affected the heterogeneity of our study to varying degrees. The sensitivity analysis showed that our results were almost robust, apart from excluding the article by Nomikos (OR = 0.77, 95% CI = 0.65-0.92) and Zeng (OR = 0.77, 95% CI = 0.65-0.91), when investigating the relationship between ApoA1 and all-cause mortality. CONCLUSION In this study, we found that Apo levels were linked to cardiovascular and all-cause mortality. Our study strengthens the evidence on the association between the level of Apos and cardiac health and may provide ideas for regulating the level of Apos to promote public health.
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Affiliation(s)
- Jiarong Zhang
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China
| | - Xinru Song
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, 169 Hushan Road, Nanjing 211166, China
| | - Zhi Li
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China
| | - Haibo Xu
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China
| | - Haotian Shu
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China
| | - Jun Li
- Department of General Surgery, The Affiliated Jiangning Hospital of Nanjing Medical University, 169 Hushan Road, Nanjing 211166, China
| | - Yan Zhang
- School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China
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Tang R, Chen J, Zhou Q, Deng J, Zhan X, Wang X, Wen Y, Su N, Feng X, Xu Q. Association between systemic immune inflammation Index and all-cause mortality in incident peritoneal dialysis-treated CKD patients: a multi-center retrospective cohort study. BMC Nephrol 2024; 25:8. [PMID: 38172773 PMCID: PMC10765751 DOI: 10.1186/s12882-023-03451-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Chronic inflammatory disorders in peritoneal dialysis (PD) contribute to the adverse clinical outcome. Systemic immune inflammation index (SII) is the novel and convenient measurement that is positively associated with various diseases. However, scarce is known regarding the association between SII with all-cause mortality among PD patients. METHODS In this multi-center retrospective cohort study, 1,677 incident patients with PD were enrolled. Eligible patients were stratified into groups based on SII level: tertile 1(< 456.76), tertile 2(456.76 to 819.03), and tertile 3(> 819.03). The primary endpoint was the all-cause mortality. Both Cox regression analysis and competing risk models were used to examine the association between SII and all-cause mortality. Subgroup analysis was performed to assess the influence of the SII tertiles on all-cause mortality in different subgroups. RESULTS During the follow-up period of 30.5 ± 20.0 months, 26.0% (437/1,677) patients died, of whom the SII tertile 3 group accounted for 39.1% (171/437) of the deaths. Patients in the SII tertile 3 group had a higher all-cause mortality rate than patients in the SII tertile 1 and 2 groups (log-rank = 13.037, P < 0.001). The SII tertile 3 group was significantly associated with 80% greater risk (95% confidence interval:1.13 to 2.85; P = 0.013) compared with the SII tertile 1 group in multivariable Cox regression analysis. The competing risk model also indicated that the relationship between SII tertiles and all-cause mortality remains (subdistribution hazard ratio: 1.86; 95% confidence interval: 1.15 to 2.02, P = 0.011). Furthermore, the relationship between the log-transformed SII and all-cause mortality in patients with PD was nearly linear (P = 0.124). CONCLUSION A close relationship was observed between the SII and all-cause mortality in patients undergoing PD, suggesting that more attention should be paid to the SII, which is a convenient and effective measurement in clinical practice.
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Affiliation(s)
- Ruiying Tang
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China
| | - Jiexin Chen
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen Univeristy, Guangzhou, China
| | - Jihong Deng
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Univeristy, ZhengZhou, China
| | - Yueqiang Wen
- Department of Nephrology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ning Su
- Department of Hematology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang NO.1 People's Hospital, Jiujiang, China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, No. 23 Hai Bang Road, Jiangmen, 529000, China.
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Jiang W, Chen Y, Yan C, Ma Y, Chen Q, Zhan X. Mean platelet volume may predict all-cause and cardiovascular mortality among incident peritoneal dialysis patients. Ren Fail 2023; 45:2261541. [PMID: 37755338 PMCID: PMC10538463 DOI: 10.1080/0886022x.2023.2261541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The association between mean platelet volume (MPV) and mortality in patients with cardiovascular disease has been demonstrated. However, the association between MPV and mortality in peritoneal dialysis (PD) patients remains unclear. METHODS Patients catheterized at the First Affiliated Hospital, Nanchang University, between November 1, 2005, and August 31, 2019, were enrolled. The primary endpoints were all-cause and cardiovascular mortality. Patients were divided into two groups according to the cutoff value, which was determined using maximally selected rank statistics. The mortality hazard ratio was evaluated using Cox regression models. RESULTS Among the 1322 PD patients enrolled, the mean age was 49.3 ± 14.5 years, 57.6% were men, and 18.8% had diabetes. During a median follow-up of 50 months (IQR: 30-80), 360 patients died; among these, 167 deaths were attributed to cardiovascular diseases. Survival analysis revealed that all-cause and cardiovascular mortality rates were lower in the higher-MPV group than in the lower-MPV group (p < .001 and p < .001, respectively). After full adjustment, a higher MPV was significantly associated with a hazard ratio of 0.77 for all-cause mortality (95% CI: 0.60-0.98, p = .036) and 0.75 for cardiovascular mortality (95% CI: 0.51-0.97, p = .041). Subgroup analysis showed that a significant interaction existed between age and MPV (p < .001). Decreased MPV was associated with higher mortality risk only in patients < 60 years old. CONCLUSIONS Our results showed that lower MPV can be associated with a higher risk of all-cause and cardiovascular mortality in patients with PD.
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Affiliation(s)
- Wenyu Jiang
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yanbing Chen
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Caixia Yan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yujiao Ma
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qinkai Chen
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Lu J, Gao J, Sun J, Wang H, Sun H, Huang Q, Zhang Y, Zhong S. Apolipoprotein A-I attenuates peritoneal fibrosis associated with peritoneal dialysis by inhibiting oxidative stress and inflammation. Front Pharmacol 2023; 14:1106339. [PMID: 37576813 PMCID: PMC10422021 DOI: 10.3389/fphar.2023.1106339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Apolipoprotein A-I (apoA-I), 90% of which is present in high-density lipoprotein (HDL), is the main constituent of HDL, has anti-inflammatory and anti-oxidant properties, and has received extensive attention in anti-atherosclerosis. Yet little is known about apoA-I 's role in peritoneal dialysis. In this study, by analyzing PD patients (n = 81), we found that decreased apoA/HDL-C ratio is significantly associated with rapid decline in peritoneal function. Further studies were performed in animal experiments to determine the ascendancy of apolipoprotein A-I mimetic peptide (D-4F) on peritoneum, we found that D-4F administration reduced peritoneal fibrosis and peritoneal endothelial mesenchymal transformation (EMT) induced by high glucose peritoneal dialysate, such as N-cadherin, Fibronectin, Vimentin, and α-smooth muscle actin (α-SMA) expression decreased. In mechanism, D-4F can significantly inhibit Smad2/3 phosphorylation, which is the major pathway leading to fibrosis. Furthermore, D-4F treatment inhibited NADPH oxidase and thiobarbituric acid reactive substances (TBARS) expression, increased the activity of certain enzymes, such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). Finally, treatment with D-4F inhibits the expression of interleukins-6(IL-6), Interleukin-1β(IL-1β), and tumor necrosis factor-α(TNF-α). Taken together, based on the above research evidence, apoA-I and its peptide mimic may regulate the oxidative stress, TGF- β1/Smads signaling pathway and inflammatory response to reduce peritoneal fibrosis due to peritoneal dialysis.
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Affiliation(s)
- Jing Lu
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jie Gao
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Sun
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Haiping Wang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Huijuan Sun
- Jinzhou First People’s Hospital, Dalian, China
| | - Qian Huang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yao Zhang
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shuo Zhong
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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