Lipid, blood pressure and kidney update 2013

Abstract

The year 2013 proved to be very exciting as far as landmark trials and new guidelines in the field of lipid disorders, blood pressure and kidney diseases. Among these are the International Atherosclerosis Society Global Recommendations for the Management of Dyslipidemia, European Society of Cardiology (ESC)/European Society of Hypertension Guidelines for the Management of Arterial Hypertension, American Diabetes Association Clinical Practice Recommendations, the Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease (CKD) Patients, the American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the Joint National Committee Expert Panel (JNC 8) Evidence-Based Guideline for the Management of High Blood Pressure in Adults, the American Society of Hypertension/International Society of Hypertension Clinical Practice Guidelines for the Management of Hypertension in the Community, the American College of Physicians Clinical Practice Guideline on Screening, Monitoring, and Treatment of Stage 1–3 CKD and many important trials presented among others during the ESC Annual Congress in Amsterdam and the American Society of Nephrology Annual Meeting—Kidney Week in Atlanta, GA. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.

Statin intolerance – an attempt at a unified definition. Position paper from an International Lipid Expert Panel

“…According to available data, side effects are class-dependent, dose-dependent, time-dependent, age-, gender-and co-morbidity dependent, and/or dependent on co-treatment with certain drugs or foods (e.g. intake of grapefruit juice > 1 l/day) [10][11][12][13][14]17]. Known risk factors (endogenous, exogenous) predisposing to clinically relevant side-effects include: highdose statin therapy, advanced age (> 70 years), female sex, family history of muscle disorders, history of CK elevation, vitamin D deficiency, renal and hepatic impairment, previous history of muscle toxicity with another lipid-lowering therapy, untreated hypothyroidism, disorders of calcium homeostasis, alcohol abuse, Asian ethnicity, low body mass index (BMI), genetic polymorphisms (e.g.…”

Ocena parametrów lipidowych u pacjentów z rozpoznanym zespołem metabolicznym w zależności od ryzyka sercowo-naczyniowego obliczonego według skali SCORE

“…Banach et al [16,17] also suggest that LDL-C in patients with multiple CV risk factors is essential to effectively manage the overall risk. On the other hand, the reviewed published evidence showing a weak and potentially misleading association between LDL-C and coronary risk in patients with chronic kidney disease (CKD) [22].…”

“…Calculation of low-density lipoprotein cholesterol (LDL-C) is also very important because it is still widely used and it is the first lipid target of therapy (IA class) according to the guidelines for the management of dyslipidaemias of the European Atherosclerosis Society and the European Society of Cardiology (ESC/EAS) [14,15]. In patients with multiple CV risk factors LDL-C is suggested as being essential to effectively manage the overall risk [16,17]. Thus, for an adequate risk analysis, at least HDL-C and LDL-C should be analysed [14].…”

Atherosclerotic renal artery stenosis

“…These studies show that for the vast majority of patients with atherosclerotic RAS and either hypertension or chronic kidney disease, treatment of atherosclerotic RAS should be limited to medical management (13). At 1-year mean follow-up of 175 patients with hypertension due to RAS treated with percutaneous transluminal renal angioplasty (PTRA), 35 patients (20%) also developed restenosis (14).…”

“…Whether patients with severe atherosclerotic RAS to a single functioning kidney, severe RAS and acute kidney injury, patients presenting with flash pulmonary edema, patients with resistant hypertension, and patients with progressive reduction of renal function might benefit from renal artery revascularization remains to be demonstrated by randomized controlled clinical trials (13,15,16).…”