Renal dysfunction and acceleration of coronary disease

Yerkey, Michael W.; Kernis, Steven J.; Franklin, Barry A.; Sandberg, Keisha R.; McCullough, Peter A.

doi:10.1136/hrt.2003.015503

Cited by 70 publications

(56 citation statements)

References 18 publications

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“…This is partly due to the observation that patients with ESRD have a cluster of CHD risk factors that most commonly include advanced diabetes; hypertension; low HDL cholesterol; hypertriglyceridemia; and, less commonly, obesity, smoking, and family history of CHD (8). It is also partly due to the unique changes that occur in ESRD and accelerate atherosclerosis, destabilize the atherosclerotic plaque, cause myocardial fibrosis, and create valvular heart disease (9). It is beyond the scope of this article to speculate on the wide range of basic mechanisms (e.g., inflammation, oxidative stress, disordered calcium-phosphorous-parathyroid hormone balance) that have been implicated in this potentially unique and serious form of CHD that occurs in ESRD (9).…”

Section: Esrd: More Than a Coronary Heart Risk Equivalentmentioning

confidence: 99%

“…It is also partly due to the unique changes that occur in ESRD and accelerate atherosclerosis, destabilize the atherosclerotic plaque, cause myocardial fibrosis, and create valvular heart disease (9). It is beyond the scope of this article to speculate on the wide range of basic mechanisms (e.g., inflammation, oxidative stress, disordered calcium-phosphorous-parathyroid hormone balance) that have been implicated in this potentially unique and serious form of CHD that occurs in ESRD (9). It should be recognized that, as a result, most patients with ESRD have significant CAD and structural heart disease (left ventricular hypertrophy and cardiac fibrosis) and therefore are at increased risk for sudden death that is triggered by myocardial ischemia, electrolyte shifts, sepsis, and other events (10).…”

Section: Esrd: More Than a Coronary Heart Risk Equivalentmentioning

confidence: 99%

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Coronary Artery Disease

McCullough

2007

Clinical Journal of the American Society of Nephrology

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Coronary heart disease is the most common cause of death in the general population and in patients with ESRD. The principles of cardiovascular risk assessment and management apply to both populations. Advances in noninvasive coronary artery imaging have improved early detection of subclinical disease. The goals of medical management of coronary disease are to modify the natural history of disease and to improve the symptoms of angina. Coronary revascularization poses a different risk and benefit equation in the ESRD population. In stable ESRD with multivessel coronary artery disease, coronary bypass surgery, despite the upfront risks of stroke, myocardial infarction, and chest wound infection, seems to be a favored approach. In patients with ESRD and acute coronary syndromes, percutaneous coronary intervention on the target vessel has been associated with the most favorable outcomes. This article explores the clinical issues with respect to coronary artery disease in patients with ESRD.Clin J Am Soc Nephrol 2: 611-616, 2007611-616, . doi: 10.2215 C oronary heart disease is the leading cause of death in the US general population. With the obesity pandemic and the expected worsening of cardiovascular risk factors in the general population, the incidence and the prevalence of heart disease is expected to rise. Coronary artery disease (CAD) is the leading cause of death in patients with chronic kidney disease (CKD): Of the more than 320,000 patients with ESRD that requires dialysis or kidney transplantation in the United States, half will die from cardiovascular causes, and patients with milder degrees of CKD are more likely to die of CAD than to develop kidney failure that requires renal replacement therapy (1).The observational studies concerning CAD and ESRD have revealed the following: (1) By the time patients reach dialysis, approximately 70% have significant coronary artery calcification indicative of coronary atherosclerosis, (2) patients with CAD and ESRD have markedly increased mortality over the general population, (3) treatment with disease-modifying therapy that is proved to reduce rates of (MI) or death (e.g., aspirin, ␤ adrenergic receptor blockers [BB], angiotensin-converting enzyme inhibitors [ACEI], 3-methylglutaryl CoA reductase inhibitors or statins) are used less frequently in patients with ESRD than in the general population, (4) noninvasive imaging seems to have less precision and accuracy in patients with ESRD, and (5) patients who have ESRD and are selected for revascularization with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) have improved survival compared with those who are treated with medical therapy alone (2-6). Table 1 presents a summary of CAD risk reduction, diagnosis, and management principles. Recommendations in Table 1 present a task list for optimal (not minimal) clinical goals and go beyond many current professional society guidelines concerning the individual treatment targets. ESRD: More Than a Coronary Heart Risk EquivalentPatients with ES...

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Section: Esrd: More Than a Coronary Heart Risk Equivalentmentioning

confidence: 99%

Section: Esrd: More Than a Coronary Heart Risk Equivalentmentioning

confidence: 99%

Coronary Artery Disease

McCullough

2007

Clinical Journal of the American Society of Nephrology

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“…Furthermore, uremic stress results in increased levels of oxidized LDL-C, a highly reactive and atherogenic species. Thus, it appears that hyperactivation of the RAS, elevated insulin levels, and the dyslipidemia of CKD work in concert to advance atherosclerosis at faster rates than in those with preserved renal function 19 . It is not surprising that the kidney as the most vascular organ is affected by the atherosclerotic process beyond the large renal artery and its major subbranches.…”

Section: Dyslipidemiasmentioning

confidence: 99%

Interseção cardiorrenal: confluência para o futuro

McCullough¹

2007

Arq. Bras. Cardiol.

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“…6 Controversies exist regarding Lp(a) levels in CRF patients with and without hemodialysis. There are few studies that showed Lp(a) levels were elevated in CRF patients, 7,8,9 Lp(a) levels were elevated in hemodialysed patients, 10 Lp(a) levels were decreased after hemodialysis 8,11 and Lp(a) levels did not vary before and after hemodialysis. 5,12 With the implication of plasma lipids and lipoproteins in the pathogenesis of atherosclerosis and ischemic heart disease, it becomes worthwhile to study the behavior of various lipid fractions in CRF patients.…”

Section: Introductionmentioning

confidence: 99%

Lipid profile and lipoprotein(a) in chronic renal failure patients with and without hemodialysis

Sharma¹,

Shah²,

Gorasia

et al. 2012

IJMEDPH

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Objectives: Chronic renal failure (CRF) is complicated by characteristic dyslipidemias. CRF patients on hemodialysis have abnormalities in lipid profile and have a high incidence of cardiovascular diseases. Lipoprotein(a) [Lp(a)] is now considered as a novel cardiovascular risk factor and its level is increased in CRF patients with and without hemodialysis. We sought to evaluate the pattern of lipid profile including Lp(a) level in CRF patients with and without hemodialysis. Methodology: Study were divided into 3 groups, Group-I: healthy controls (30), Group-II: CRF patients who never undergone hemodialysis (30) and Group-III: CRF patients on hemodialysis for more than 6 months (30). We obtained serum samples from patients in the morning after an overnight fast and were analysed for total cholesterol (TC), triglycerides (TGs), HDL, LDL, Lp(a) using standard colorimetric assays on fully automated analyzer. VLDL concentration was calculated using Friedewald's Formula. Results: Among the various parameters tested triglyceride and VLDL levels were significantly higher in group-II and III as compared to controls (p<0.01). HDL levels were significantly lower in group-II and III as compared to control (p<0.05). HDL level was found reduced in group-III as compared to Group-II (p<0.01). There was no significant change (p>0.05) observed in total cholesterol and LDL levels in between healthy controls and CRF patients with & without hemodialysis. Lp(a) levels were significantly higher in group-II and III as compared to controls (p<0.01) but the difference between Lp(a) levels in group-II and III was found insignificant (p>0.05). There was no significant difference (p>0.05) observed between Lp(a) levels and lipid profile in male and female patients in control group and in CRF patients with and without hemodialysis. Conclusions: This study demonstrated that CRF patients with and without hemodialysis are at greater risk of development of dyslipidemias, characterized by hypertriglyceridemia, elevated VLDL and Lp(a) levels and decreased HDL levels. Total cholesterol and LDL cholesterol levels remain normal or decreased in these patients. Both male and female patients of CRF with and without hemodialysis have dyslipidemias without any discrimination of sex and it is not attenuated by the hemodialysis process.

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Renal dysfunction and acceleration of coronary disease

Cited by 70 publications

References 18 publications

Coronary Artery Disease

Coronary Artery Disease

Interseção cardiorrenal: confluência para o futuro

Lipid profile and lipoprotein(a) in chronic renal failure patients with and without hemodialysis

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