title: Controversies Regarding Lipid Management and Statin Use for Cardiovascular Risk Reduction in Patients With CKD.
abstract: Adults with chronic kidney disease (CKD) are at heightened risk for dying of cardiovascular disease. Results from randomized clinical trials of statin drugs versus placebo demonstrate that statin drugs or statin plus ezetimibe reduce the absolute risk for coronary heart disease and mortality among adults with non-dialysis-dependent CKD. The Kidney Disease: Improving Global Outcomes 2013 clinical practice guideline for lipid management in CKD recommends that adults 50 years or older with non-dialysis-dependent CKD be treated with a statin or statin plus ezetimibe regardless of low-density lipoprotein cholesterol levels. However, at least 9 guidelines published during the last 5 years address lipid management for primary and secondary prevention of atherosclerotic cardiovascular disease, and not all guidelines address the utility of lipid-lowering therapy in adults with CKD. Because most patients with CKD receive most of their clinical care from non-nephrologists, differences in recommendations for lipid-lowering therapy for cardiovascular disease prevention may negatively affect the clinical care of adults with CKD and cause confusion for both patients and providers. This review addresses the identification and management of lipid levels in patients with CKD and discusses the existing controversies regarding testing and treatment of lipid levels in the CKD population.
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Talar
authors.initials: T
authors.lastname: Markossian
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Burge
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ling
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Julia
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Ivan
authors.initials: I
authors.lastname: Pacold
authors.affiliation: Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Vinod
authors.initials: V
authors.lastname: Bansal
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: David
authors.initials: D
authors.lastname: Leehey
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL.
authors.forename: Kevin
authors.initials: K
authors.lastname: Stroupe
authors.affiliation: Department of Medicine, Geisinger Medical Center, Danville, PA.
authors.forename: Alex
authors.initials: A
authors.lastname: Chang
authors.affiliation: Hines Veterans Administration Hospital, Hines, IL; Department of Medicine, Loyola University Chicago, Maywood, IL. Electronic address: hkramer@luc.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents
keywords: ASCVD; CKD; Cholesterol; atherosclerotic cardiovascular disease; cardiovascular disease; coronary heart disease; drug safety; guidelines; high density lipoprotein cholesterol; lipids; low density lipoprotein cholesterol; mortality; review; risk score; statin; treatment recommendations