Achievement of Therapeutic Goals and Utilization of Evidence-Based Cardiovascular Therapies in Coronary Heart Disease Patients With Chronic Kidney Disease

Lahoz, Carlos; Mostaza, J.M.; Mantilla, María Teresa; Taboada, Manuel; Tranche, Salvador; López-Rodríguez, Isidro; Monteiro, Beatriz P.; Soler, Begoña; Sánchez-Zamorano, Miguel A.; Martín-Jadraque, Raquel

doi:10.1016/j.amjcard.2007.12.009

Cited by 18 publications

(5 citation statements)

References 21 publications

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“…Further confounding this issue is variability in the response of CKD patients to therapeutic interventions on lipids. Although lipid-lowering agents prevent CV events in patients with mild to moderate CKD (5-10), their effectiveness appears more equivocal as renal damage progresses to end stage renal disease (5,11,12). These observations suggest that renal dysfunction may exert a unique influence over the process of atherogenesis, and may influence response to standard lipid therapy.…”

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confidence: 99%

Renal Dysfunction Potentiates Foam Cell Formation by Repressing ABCA1

Zuo

Yancey

Castro

et al. 2009

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Objective-Patients with chronic kidney disease (CKD) have the highest risk for atherosclerotic cardiovascular disease (CVD). Current interventions have been insufficiently effective in lessening excess incidence and mortality from CVD in CKD patients versus other high-risk groups. The mechanisms underlying the heightened risk remain obscure but may relate to differences in CKD-induced atherogenesis, including perturbation of macrophage cholesterol trafficking. Methods and Results-We examined the impact of renal dysfunction on macrophage cholesterol homeostasis in the apoE Ϫ/Ϫ mouse model of atherosclerosis. Renal impairment induced by uninephrectomy dramatically increased macrophage cholesterol content, linked to striking impairment of macrophage cholesterol efflux. This blunted efflux was associated with downregulation of the cholesterol transporter ATP-binding cassette transporter A1 (ABCA1) and activation of the nuclear factor-kappa B (NF-B). Treatment with the angiotensin receptor blocker (ARB) losartan decreased NF-B and restored cholesterol efflux. Key Words: renal impairment Ⅲ atherosclerosis Ⅲ macrophage Ⅲ ATP-binding cassette transporter A1 Ⅲ angiotensin P atients with chronic kidney disease (CKD), including those with mild renal dysfunction, have very high risk for cardiovascular disease (CVD). [1][2][3] Our limited understanding of the underlying mechanisms of CKD-driven vasculopathy constrains development of specific therapeutic approaches. While risk reductions, through current therapeutic interventions, have halved the overall CVD morbidity and mortality in the general population, 4 poor CV outcomes continue to escalate in CKD patients. 1 Further confounding this issue is variability in the response of CKD patients to therapeutic interventions on lipids. Although lipid-lowering agents prevent CV events in patients with mild to moderate CKD, 5-10 their effectiveness appears more equivocal as renal damage progresses to end-stage renal disease. 5,11,12 These observations suggest that renal dysfunction may exert a unique influence over the process of atherogenesis, and may influence response to standard lipid therapy. Conclusions-OurAlthough renal damage can cause dyslipidemia, the increased incidence of CVD in CKD cannot be attributed to higher serum cholesterol per se. 13 Recent studies indicate that multiple local vascular perturbations influence cholesterol trafficking and foam cell formation, a key process in atherogenesis. 14 -16 There is currently little information about foam cell formation in the setting of renal dysfunction. The formation of macrophage foam cells reflects a failure of cholesterol export mechanisms to keep pace with internalization of cholesterol from lipoproteins and cellular debris. 14 Thus, macrophage cholesterol homeostasis is critically dependent on lipid efflux, which involves mobilization of excess cholesterol from intracellular pools to the plasma membrane and transfer to suitable external cholesterol acceptors. 14 -16 The key pathway for cholesterol movement out of ...

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confidence: 99%

Renal Dysfunction Potentiates Foam Cell Formation by Repressing ABCA1

Zuo

Yancey

Castro

et al. 2009

ATVB

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“…Despite the greater risk of mortality in patients with chronic HF and CKD, evidence has suggested that guideline-recommended therapies for HF are less likely to be provided to patients with comorbid chronic HF and CKD [57,[59][60][61]. In our experience cited above [49], we observed that patients who died were taking during follow-up less frequently diuretics and beta-blockers than those who survived, indicating possible history of intolerance, specific contraindications or evidence of side effects.…”

Section: Chronic Hf and Ckdmentioning

confidence: 61%

Left ventricular systolic dysfunction in chronic kidney disease: from asymptomatic changes in geometry and function to overt heart failure

Cioffi

Tarantini

Faggiano

et al. 2015

Monaldi Arch Chest Dis

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A bidirectional relationship between kidney and heart function is present in all stages of cardiac and renal disease, from the asymptomatic phase of left ventricular systolic dysfunction to overt heart failure, as well as from the initial reduction of glomerular filtration rate to end-stage kidney disease, respectively. The simultaneous presence of both diseases has a significant impact on prognosis and requires specific therapeutic strategies. The early recognition of abnormalities of renal and myocardial function may have a relevant influence on management of combination of these conditions.

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“…In the present study, the prevalence of advanced CKD in nursing home residents is approximately 30%, but only 13% have optimal control of all risk factors (eg obesity, hypertension and dyslipidaemia). One study in Spain recruited people with recent coronary events; it was found that only 11.8% of them with CKD had cardiovascular disease risk factors all well controlled, though they were prescribed more diuretics, calcium channel blockers and angiotensin II receptor blockers than those without CKD (13). Physicians who care for nursing home residents should pay more attention to their achievement of therapeutic goals of cardiovascular disease for prevention of further events that impair ADL.…”

Section: Resultsmentioning

confidence: 99%