title: Potential effects of reclassifying CKD as a coronary heart disease risk equivalent in the US population.
abstract: BACKGROUND
  Persons with chronic kidney disease (CKD) are at high risk for cardiovascular disease events, but are not classified as such in current US cholesterol treatment guidelines. We examined potential effects of modified guidelines in which CKD was considered a "coronary heart disease (CHD) risk equivalent" for risk stratification.
  
  
  METHODS
  Nationally representative cross-sectional study.
  
  
  METHODS
  4,823 adults 20 years or older from the 2007-2010 National Health and Nutrition Examination Survey.
  
  
  METHODS
  Cardiovascular risk stratification based on current US cholesterol treatment guidelines and 2 simulated scenarios in which CKD stages 3-5 or CKD stages 1-5 were considered a CHD risk equivalent.
  
  
  METHODS
  Proportion of persons with low-density lipoprotein (LDL) cholesterol at levels above treatment targets and above the threshold for lipid-lowering therapy initiation, based on current guidelines and the 2 simulated scenarios.
  
  
  RESULTS
  Under current guidelines, 55.1 million adults in 2010 did not achieve the target LDL cholesterol goal. Of these, 25.2 million had sufficiently elevated levels to meet recommendations for initiating lipid-lowering therapy; 12.1 million were receiving this therapy but remained above goal. When CKD stages 3-5 were considered a CHD risk equivalent, 59.2 million persons were above target LDL cholesterol goals, with 28.5 million and 13.3 million meriting therapy initiation and intensification, respectively. When CKD stages 1-5 were considered a CHD risk equivalent, 65.2 million adults were above goal, with 33.9 million and 14.4 million meriting therapy initiation and intensification, respectively.
  
  
  CONCLUSIONS
  CKD and LDL cholesterol defined using a single laboratory value.
  
  
  CONCLUSIONS
  Many adults in the United States currently do not meet recommended goals for LDL cholesterol levels. Modifying the current cholesterol guidelines to include CKD as a CHD risk equivalent would lead to a substantial increase in both the number of persons with levels above LDL cholesterol treatment targets and those recommended to initiate lipid-lowering therapy.
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD.
authors.forename: Meredith C
authors.initials: MC
authors.lastname: Foster
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD.
authors.forename: Andreea M
authors.initials: AM
authors.lastname: Rawlings
authors.affiliation: Merck, Sharp & Dohme Corp, Whitehouse Station, NJ.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Marrett
authors.affiliation: Merck, Sharp & Dohme Corp, Whitehouse Station, NJ.
authors.forename: David
authors.initials: D
authors.lastname: Neff
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.affiliation: National Kidney Foundation, New York, NY.
authors.forename: Kerry
authors.initials: K
authors.lastname: Willis
authors.affiliation: William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA.
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: lselvin@jhsph.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000379:methods*; D011634:Public Health; D051436:Renal Insufficiency, Chronic / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL
keywords: Chronic kidney disease; National Health and Nutrition Examination Survey (NHANES); cholesterol treatment guidelines; coronary heart disease (CHD) risk equivalents; guideline implementation; low-density lipoprotein (LDL) cholesterol; public health