Critical Appraisal of the SHARP Trial: The Results May Be Dull

Harbin, Megan; Amadio, Anthony; Tejani, Aaron M

doi:10.1016/j.clinthera.2014.10.008

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…LDL cholesterol levels are less predictive of cardiovascular risk in CKD, especially in those with lower GFR. Despite this, the benefit of lipid lowering in this population has been demonstrated (23, 24). While total cholesterol in the general population is linked to the risk of developing and dying from CVD, data from the CKD population have been less clear.…”

Section: The Lipid Profile In Ckd and Its Relationship With Cvdmentioning

confidence: 99%

“…Over the median follow up 4.9 years, the study showed no significant difference between the two groups for coronary deaths, but the treatment group showed lower LDL and a significant 17% reduction in the risk of combined major atherosclerotic events, such as non-fatal myocardial infarction, ischemic stroke or coronary revascularization procedures. Overall mortality was unaffected (23, 24). The study was underpowered to detect the effects separately between dialysis and non-dialysis patients but a trend to reduced benefit of simvastatin/ezetimibe from Stage 3 successively to Stage 5 disease and ESRD was observed.…”

Section: Treatment Approachesmentioning

confidence: 99%

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Cholesterol Metabolism in CKD

Reiss

Voloshyna

Leon

et al. 2015

American Journal of Kidney Diseases

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Patients with chronic kidney disease (CKD) have a substantial risk of developing coronary artery disease. Traditional cardiovascular disease (CVD) risk factors such as hypertension and hyperlipidemia do not adequately explain the high prevalence of CVD in CKD. Both CVD and CKD are inflammatory states and inflammation adversely impacts lipid balance. Dyslipidemia in CKD is characterized by elevated triglycerides and high density lipoprotein that is both decreased and dysfunctional. This dysfunctional high density lipoprotein becomes pro-inflammatory and loses its atheroprotective ability to promote cholesterol efflux from cells, including lipid-overloaded macrophages in the arterial wall. Elevated triglycerides result primarily from defective clearance. The weak association between low density lipoprotein cholesterol level and coronary risk in CKD has led to controversy over the usefulness of statin therapy. This review examines disrupted cholesterol transport in CKD, presenting both clinical and pre-clinical evidence of the impact of the uremic environment on vascular lipid accumulation. Preventative and treatment strategies are explored.

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Section: The Lipid Profile In Ckd and Its Relationship With Cvdmentioning

confidence: 99%

Section: Treatment Approachesmentioning

confidence: 99%

Cholesterol Metabolism in CKD

Reiss

Voloshyna

Leon

et al. 2015

American Journal of Kidney Diseases

View full text Add to dashboard Cite

show abstract

“…According to large randomized Study of Heart and Renal Protection (SHARP) in patients with lower LDL level following treatment (simvastatin 20 mg daily plus ezetimibe 10 mg daily) a significant 17% reduction in the risk of combined major atherosclerotic events, including ischemic stroke, non-fatal myocardial infarction, or coronary revascularization procedures is reported [103,104]. A meta-analysis of 50 trials failed to show the improvement in all-cause mortality in statin-treated CKD patients with significantly reduced lipid concentrations [105].…”

Section: Risk Associated With Bad Cholesterol Profile and Benefitsmentioning

confidence: 99%

Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients

2019

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Chronic kidney disease (CKD) is a widespread disease with increasing prevalence in the modern society. Lipid disturbances are common in this group of patients. In most patients with CKD atherogenic dyslipidemia is observed. Dyslipidemia in patients with renal diseases increases the risk of cardiovascular diseases and it accelerates the progression of chronic kidney disease to its end stage. The amelioration of dyslipidemia and the lowering of oxidative stress, inflammatory processes, insulin sensitivity and remnant lipoproteins levels may lead to the reduction in cardiovascular burden. Nutritional interventions can strengthen the beneficial effect of treatment and they play an important role in the preservation of overall well-being of the patients with CKD since the aim of appropriate diet is to reduce the risk of cardiovascular events, prevent malnutrition, and hamper the progression of kidney disease. The management of dyslipidemia, regardless of the presence of chronic kidney disease, should be initiated by the introduction of therapeutic lifestyle changes. The introduction of diet change was shown to exert beneficial effect on the lipid level lowering that reaches beyond pharmacological therapy. Currently available evidence give the impression that data on dietary interventions in CKD patients is not sufficient to make any clinical practice guidelines and is of low quality.

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Critical Appraisal of the SHARP Trial: The Results May Be Dull

Cited by 2 publications

References 17 publications

Cholesterol Metabolism in CKD

Cholesterol Metabolism in CKD

Cholesterol Disturbances and the Role of Proper Nutrition in CKD Patients

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