Stage of chronic kidney disease and severity of coronary heart disease manifestation

Aristotle University of Thessaloniki, Hippocration Hospital, Medical School, 2nd Propedeutic Department of Internal Medicine , Thessaloniki , Greece.
Expert Opinion on Pharmacotherapy (Impact Factor: 3.53). 03/2012; 13(4):457-60. DOI: 10.1517/14656566.2012.661716
Source: PubMed


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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Available from: Vasilios Gabriel Athyros, Dec 07, 2015
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    • "Patients with stage 3 - 5 CKD make up a substantial proportion of high-risk patients with cardiovascular disease (30% of coronary heart disease patients and 20 - 40% of diabetic patients) [10-12]. Patients with both T2DM and CKD are at particularly high risk of cardiovascular disease [13-17] and it is imperative to monitor their GFR. "
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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.
    Full-text · Article · Sep 2012 · The Open Cardiovascular Medicine Journal
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    • "Furthermore, heavy binge drinking may cause acute renal failure [186]. CKD has been associated with the presence and severity of CHD [187] [188]. Therefore, the prevention of CKD development can significantly minimize an individual's vascular risk. "

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    ABSTRACT: Background: Smoking adversely affects cardiovascular disease (CVD) morbidity and mortality; however the effect of long-term statin treatment in high risk smokers is not entirely clear. The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) study (n=1,600 patients with established coronary heart disease, mean follow-up 3-years) was the incidence of major CVD events, a composite of death, myocardial infarction, revascularization, unstable angina, heart failure, and stroke in statin-treated patients (n=880) who continued to smoke (n=129) compared with ex-smokers (n=309) and never smokers (n=442) as well as on patients not treated with a statin (n=720) of all smoking categories. Secondary endpoints were the effect of smoking on chronic kidney disease (CKD) and on non-alcoholic fatty liver disease (NAFLD), two major and common independent CVD risk factors. Results: Among statin treated patients the hazard ratio (HR) for current smokers compared with never smokers was 1.86 [95% confidence interval-(CI) 1.19-2.10); similar was the HR for current smokers compared with ex-smokers. Absolute (16.3%) and relative (45.6%) CVD risk reduction was great in current smokers on statins compared with those not on a statin; however they still had the highest absolute CVD event incidence (19.4%). Low high density lipoprotein cholesterol and higher triglycerides may account, at least in part, for this. The highest risk of CVD events in any of the 6 groups was in the smokers not on a statin (35.7%). CKD and NAFLD were not negatively affected by smoking and they do not appear to be implicated in the adverse effect of smoking on CVD event rate in patients on a statin. Conclusions: Statins reduce CVD morbidity and mortality in current smokers with CVD, but these remain high in terms of absolute incidence compared with ex- and never smokers. CKD and NAFLD are not affected by smoking and do not seem to contribute to this high CVD event incidence. These make smoking cessation imperative in high risk patients even if they are on statins.
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