Stage of chronic kidney disease and severity of coronary heart disease manifestation.
ABSTRACT A recent study suggested that patients with chronic kidney disease (CKD) with a glomerular filtration rate (GFR) < 45 ml/min/1.73 m(2) are more likely to present with acute myocardial infarction (AMI) than with stable exertion angina. Thus, the degree of renal impairment seems to be related to the presentation of coronary heart disease (CHD). In this context, there is evidence indicating that statins decrease the excess risk for AMI and other CHD-related events in patients with CKD (although the benefit may depend on the stage of CKD). This effect might be attributed to stabilization of atherosclerotic plaques, which seem to be more vulnerable if CKD is present. Thus, statin treatment in early CKD, a condition considered to be a CHD equivalent by several guidelines, is likely to minimize the risk for CHD events.
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ABSTRACT: This is a case report that describes a 67-year-old woman with mixed hyperlipidemia and diabetic nephropathy. She was initially prescribed a combination of simvastatin plus gemfibrozil by her general practitioner (GP). When referred to our cardiovascular unit, we further diagnosed the patient to have mixed hyperlipidemia and rhabdomyolysis. Because of concerns with her chronic kidney disease (CKD), we temporarily stopped all her drug treatments and started insulin treatment for her type 2 diabetes (T2D). A month later when her T2D was stabilised, we prescribed atorvastatin and an omega-3 fatty acid ethyl ester supplement to treat her hypertriglyceridemia. Within two months her blood lipids were within the recommended range. In patients with stage 3-5 CKD, it is not advisable to prescribe the fibrate gemfibrozil, particularly in combination with a statin that is metabolised predominantly in the kidneys. To minimise adverse events without compromise on efficacy, we used a combination of omega-3 fatty acid ethyl esters, which are not metabolised in the kidneys, with a statin that is minimally metabolised in the kidneys for the treatment of her hyperlipidemia.The Open Cardiovascular Medicine Journal 01/2012; 6:122-5.