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Beyond (or Back to) Traditional Risk Factors: Preventing Cardiovascular Disease in Patients with Chronic Kidney Disease

2004; American College of Physicians; Volume: 140; Issue: 1 Linguagem: Inglês

10.7326/0003-4819-140-1-200401060-00013

1539-3704

Lawrence J. Appel,

Chronic Kidney Disease and Diabetes

Editorials6 January 2004Beyond (or Back to) Traditional Risk Factors: Preventing Cardiovascular Disease in Patients with Chronic Kidney DiseaseLawrence J. Appel, MD, MPHLawrence J. Appel, MD, MPHFrom Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21205.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-1-200401060-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Patients with chronic kidney disease carry an extraordinarily high risk for cardiovascular disease (CVD). In fact, most patients with chronic kidney disease will die of CVD before reaching end-stage kidney disease (1). A logical starting point for CVD prevention efforts in this population is determining the extent to which traditional CVD risk factors (that is, smoking, blood pressure, diabetes, and hypercholesterolemia) are responsible for the excess risk for CVD. In this issue, Muntner and colleagues (2) highlight the possibility that other risk factors, commonly termed nontraditional risk factors, also contribute to the burden of CVD in this population.The setting ...References1. Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG, et al . 1989 Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. Hypertension. 13:I80-93. [PMID: 2490833] CrossrefMedlineGoogle Scholar2. Muntner P, Hamm LL, Kusek JW, Chen J, Whelton PK, He J. 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Long-term effects of pravastatin on plasma concentration of C-reactive protein. The Cholesterol and Recurrent Events (CARE) Investigators. Circulation. 1999;100:230-5. [PMID: 10411845] CrossrefMedlineGoogle Scholar11. Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 1995;274:1049-57. [PMID: 7563456] CrossrefMedlineGoogle Scholar12. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA. 2002;288:2015-22. [PMID: 12387654] CrossrefMedlineGoogle Scholar13. Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, et al . Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290:898-904. [PMID: 12928466] CrossrefMedlineGoogle Scholar14. Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, et al . Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003;290:891-7. [PMID: 12928465] CrossrefMedlineGoogle Scholar15. Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA. 2003;290:932-40. [PMID: 12928471] CrossrefMedlineGoogle Scholar16. Sarnak MJ, Coronado BE, Greene T, Wang SR, Kusek JW, Beck GJ, et al . Cardiovascular disease risk factors in chronic renal insufficiency. Clin Nephrol. 2002;57:327-35. [PMID: 12036190] CrossrefMedlineGoogle Scholar17. Ohkubo T, Imai Y, Tsuji I, Nagai K, Watanabe N, Minami N, et al . Relation between nocturnal decline in blood pressure and mortality. The Ohasama Study. Am J Hypertens. 1997;10:1201-7. [PMID: 9397237] CrossrefMedlineGoogle Scholar18. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al . Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med. 2003;348:2407-15. [PMID: 12802026] CrossrefMedlineGoogle Scholar19. for the AASK Study Group. Phillips RA, Appel LJ, Gabriel A. Gassman J, Diurnal patterns of BP in African Americans with hypertensive kidney disease: results from the AASK Cohort Study. Am J Hypertension. 2003;16:99A. CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21205.Acknowledgments: The author thanks Thomas Erlinger, Jeff Fink, Eliseo Guallar, Edgar Miller, and Jean Marie Ricketts for their insightful comments on draft versions of this editorial.Grant Support: Research grants DK61022 and DK45430 from the National Institute of Diabetes, Digestive and Kidney Diseases.Disclosures: None disclosed.Corresponding Author: Lawrence J. Appel, MD, MPH, Johns Hopkins University, 2024 East Monument Street, Suite 2-600, Baltimore, MD 21205-2223; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Prevalence of Nontraditional Risk Factors for Coronary Heart Disease in Patients with Chronic Kidney Disease Paul Muntner , L. Lee Hamm , John W. Kusek , Jing Chen , Paul K. 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