Plasma from the ischemic and reperfused heart stimulates the expression of IL-1 beta and IL-8 in leukocytes. Therefore, leukocyte-derived cytokines may contribute to the regulation of cardiac inflammatory responses in patients with an acute MI.

Abstract. This review focuses on the association between mild renal insufficiency (stage 2 and 3 of chronic kidney disease) and cardiovascular disease and discusses therapeutic options. Although the association of chronic renal insufficiency and cardiovascular risk was first shown in patients with end-stage renal disease, even minor renal dysfunction is now established as an independent risk for atherosclerotic cardiovascular disease. The association has been established in patients with a high cardiovascular risk but also in the general population. Treatment with angiotensin-converting enzyme inhibitors and statins can reduce cardiovascular morbidity and mortality in patients with renal insufficiency. Coronary revascularization improves the prognosis in patients with minor renal dysfunction, but there is still an underutilization of coronary revascularization procedures in people with renal insufficiency. The use of coronary stenting has now reduced the incidence of restenosis in these patients, and there is hope that the development of new devices will improve the prognosis in patients with renal insufficiency as well. Nevertheless, people with cardiovascular disease and renal insufficiency die significantly more often than people without renal insufficiency independent of prior successful treatment. Further investigations should focus on the causes of and possible preventive interventions for the staggering cardiovascular risk in the everincreasing number of people with minor renal dysfunction. Cardiovascular disease is common in patients with renal insufficiency. The association between renal insufficiency and cardiovascular disease was first shown in patients with end-stage renal disease, whose cardiovascular mortality exceeds that of patients without renal disease by a factor of 20 to 40. Even in adolescents with end-stage renal disease, there is a staggering cardiovascular risk (1). However, the impact of renal insufficiency on the development of atherosclerotic cardiovascular disease probably begins with minor renal dysfunction (2). Until recently, there was little evidence linking minor renal dysfunction (stage 2 and 3 of chronic kidney disease) to an increased cardiovascular risk. Here, we review the evidence and therapeutic options. Renal Insufficiency in People Not Selected for Cardiovascular Risk FactorsPatients with varying degrees of renal insufficiency have a predisposition to accelerated atherosclerosis and its consequences even in the absence of traditional cardiovascular risk factors (3). One of the first studies to assess minor renal dysfunction as a predictor of cardiovascular risk in a general population was the Framingham Heart Study (4); 6233 individuals with a mean age of 54 yr were followed for a mean of 15 yr. Minor renal dysfunction was present in 8% of women and 9% of men at baseline and was associated with a 40% greater all-cause mortality in men but not in women. However, there were only trends but no significant association between mild renal insufficiency and future cardiovascula...

Patients with renal insufficiency do not show an increased incidence of restenosis after coronary revascularization.

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Objective: Whether patients with renal insufficiency (RI) undergoing percutaneous coronary interventions (PCI) benefit from abciximab added to clopidogrel plus aspirin is unknown. Methods: The study included 2,159 patients with coronary artery disease undergoing elective PCI. RI was assessed using glomerular filtration rate (GFR) cutoff values: moderate-to-severe RI (GFR ≤60 ml/min), mild RI (GFR >60 to ≤90 ml/min) and no RI (GFR >90 ml/min). The 30-day incidence of major adverse cardiac events (MACE) and bleeding were the primary outcome analyses. Results: In patients with moderate-to-severe RI, mild RI and no RI, MACE occurred in 5.2, 5 and 2.9%, respectively, in the abciximab group (p = 0.14) and in 4.2, 3.8 and 4.0%, respectively, in the placebo group (p = 0.96). In the abciximab group, bleeding complications occurred in 8.9% of patients with moderate-to-severe RI, in 2.0% with mild RI and in 2.1% with no RI (p < 0.001). Multivariable analysis identified GFR as an independent correlate of MACE (p = 0.03) and bleeding (p = 0.001) with a trend for an interaction between GFR and abciximab regarding major bleeding (p = 0.22). Conclusions: In patients with RI undergoing PCI, adding abciximab to clopidogrel plus aspirin increases the risk of bleeding without benefit in reducing the risk of ischemic complications within the first 30 days.