Cardiovascular atherosclerotic disease

Hyperlipidemia plays a role in the development of cardiovascular disease (CVD) in patients with CKD. The primary goal of treatment of dyslipidemras is to decrease the risk of atherosclerotic cardiovascular disease. A secondary goal in patients with CKD is to reduce proteinuria and decline in kidney function. Treatment of hyperlipidemia in patients with CKD has been demonstrated to slow the decline in GFRby 1.9 mL/minute per year of treatment with antihyper Epidemic agents.21... 

In patients treated for secondary intervention, symptoms of atherosclerotic cardiovascular disease, such as angina or intermittent claudication, may improve over months to years. Xanthomas or other external manifestations of hyperlipidemia should regress with therapy. 

The rate should not exceed 25 mg/min in elderly patients and those with known atherosclerotic cardiovascular disease. 

The primary goal of lipid-lowering therapies in CKD is to decrease the risk for progressive atherosclerotic cardiovascular disease (Table 76-1). 

Lowering cholesterol levels can arrest or reverse atherosclerosis in all vascular beds and can significantly decrease the morbidity and mortality associated with atherosclerosis. Each 10% reduction in cholesterol levels is associated with an approximately 20% to 30% reduction in the incidence of coronary heart disease. Hyperlipidemia, particularly elevated serum cholesterol and low density lipoprotein (LDL) levels, is a risk factor in the development of atherosclerotic cardiovascular disease. 

Treatment of hyperlipidemia is based on the assumption that lowering serum lipids decreases morbidity and mortality of atherosclerotic cardiovascular disease. 

Defronzo, R. A., and Ferrannini, E. (1991). Insulin resistance A multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 14, 173-194. 

Edetate calcium disodium is indicated chiefly for the chelation of lead, but it may also have usefulness in poisoning by zinc, manganese, and certain heavy radionuclides. In spite of repeated claims in the alternative medicine literature, EDTA has no demonstrated usefulness in the treatment of atherosclerotic cardiovascular disease. 

Patrono C, Bachmann E Baigent C, et al. European Society of Cardiology. Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. Eur Heart J 2004 25 166-181. 

Atherosclerotic cardiovascular disease HMG co-A reductase inhibitors Lovastatin Pravastatin Simvastatin Primary and secondary prevention of coronary heart disease (CHD) reduced hospitalizations, percutaneous transluminal coronary angioplasties (PTCA), and coronary artery bypass graft surgeries (CABG) reduced all-cause mortality 4S AFCAPS CARE LIPID WOSCOPS >30,000 7,8... 

Type 2 diabetes and insulin resistance per se are frequently associated with dyslipidemia (i.e., borderline elevation of LDL cholesterol, elevated triglycerides, and low HDL cholesterol), and a markedly increased incidence of atherosclerotic disease (i.e., coronary, cerebral, and peripheral artery disease). Atherosclerotic cardiovascular disease is... 

The primary goal of therapy is the control of the hypercholesterolemia and prevention of atherosclerotic cardiovascular disease. Patients with heterozygous FH can usually be successfully treated with medications to lower the LDL cholesterol to acceptable levels (Table 14-2). They are generally responsive to treatment with statins, alone or in combination with other drugs, such as bile acid sequestrants (such as cholestyramine) or cholesterol absorption inhibitors (such as ezetimibe) that act additively to upregulate the expression of the functioning LDL receptor as described in the Biochemical Perspectives section. In a few cases, a more aggressive treatment with LDL apheresis (discussed in this section) may have to be considered in order to reach acceptable LDL cholesterol levels. 

Kelley JL, Chi DS, Abou-Auda W, et al. The molecular role of mast cells in atherosclerotic cardiovascular disease. Mol Med Today 2000 Aug 6 304 8. 

Sanz J, Fayad ZA (2008) Imaging of atherosclerotic cardiovascular disease. Nature 451 953-957... 

Thompson PD, Bucner D, PinalL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease A statement from the Council on Chnical Cardiology (Subcommittee on Exercise, Rehabihtation and Prevention) and the Council on Nutrition, Physical Activity, and Metabohsm (Subcommittee on Physical Activity). Circulation 2003 107 3109-3116. 

Persons at greatest risk for NSAID hemodynamic nephropathy generally have pre-existing renal insufficiency, medical problems associated with high plasma renin activity (hepatic disease with ascites, decompensated congestive heart failure, or intravascular volume depletion), or systemic lupus erythematosus. Additional risk factors include atherosclerotic cardiovascular disease and diuretic therapy. The elderly are also at higher risk due to interaction of prevalent medical problems, multiple drug therapies, and reduced renal hemodynamics. Advanced age, however, has not been shown to be an independent risk factor for toxicity in limited trials in otherwise healthy elderly subjects. Combined NSAID and ACEl or ARB therapy is also a concern and should be avoided. 

An abnormal lipoprotein profile increases the risk of atherosclerosis and coronary heart disease in patients with nephrotic syndrome. It is therefore prudent to treat patients with persistent nephrotic syndrome and sustained dyshpidemia, especially those with high VLDL and LDL cholesterol levels in the presence of a normal or low HDL cholesterol level (see Chaps. 21 and 43). Therapy is especially needed for those with concurrent atherosclerotic cardiovascular disease, or with additional risk factors for atherosclerosis, such as smoking and hypertension. Whether correction of hpoprotein abnormahties will slow the progression of renal disease as demonstrated in animal studies requires clinical confirmation. ... 

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