Preventing cardiovascular outcome in patients with renal impairment: is there a role for lipid-lowering therapy?
Patients with chronic kidney disease (CKD), ranging from modest renal impairment to dialysis and transplant, have an increased risk for cardiovascular disease (CVD). Patients with CKD have both traditional and non-traditional risk factors for CVD. The role of lipids as risk factors for CVD in these populations has not been firmly established. In a recent prospective controlled trial, it was established that atherogenic lipids are indeed strong risk factors for CVD in renal transplant recipients, and that treatment with a HMG-CoA reductase inhibitor reduced the incidence of cardiac death and myocardial infarction. For patients receiving dialysis, the association between serum lipid levels and cardiovascular outcome is uncertain and there is no evidence from controlled trials that lipid-lowering therapy does have a beneficial effect on cardiovascular outcome in these patients. Atherogenic lipids are probably a risk factor for patients with mild or moderate CKD, and five subgroup analyses have indicated a favorable effect of lipid-lowering therapy on cardiovascular outcome, although we still lack prospective controlled trials in these patients. CVD in patients with CKD has been a neglected area of research.
Medical Department, National Hospital, University of Oslo, Oslo, Norway. hallvard.holdaas@rikshospitalet.no
Hallvard
H
Holdaas
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000150:complications* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy; D016030:Kidney Transplantation / Q000502:physiology; D006435:Renal Dialysis
D000960:Hypolipidemic Agents