Addressing cardiovascular disease in patients with renal disease.
It is well-established that patients with renal disease are at increased risk of cardiovascular disease (CVD) death. Despite better understanding of CVD in endstage renal disease (ESRD) patients and more rigid guidelines addressing the major risk factors for CVD in this population, CVD continues to be the number one cause of death in patients with ESRD. Moreover, higher rates of CVD are seen in patients with moderate, and even mild, renal dysfunction and in patients with albuminuria (micro and macroscopic). Few studies with CVD endpoints have included patients with renal disease. There is sufficient evidence to support appropriate blood pressure reduction as having a beneficial effect on CVD morbidity and mortality in patients with renal disease (especially for patients with diabetes). Data supporting the benefit of modification of other CVD risk factors is not as strong, but current recommendations do stress aggressive control of lipids, smoking cessation, and maintenance of adequate nutritional status. Inclusion of patients with renal disease in studies with CVD endpoints is necessary. Until then, it is generally recommended that CVD risk stratification and modification strategies be applied to this high-risk population.
Crook
Errol D
ED
Wayne State University School of Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA. ecrook@dmc.org
Washington
David O
DO
D000419:Albuminuria / Q000150:complications; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality; D012307:Risk Factors; D014481:United States