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CKD creates similar coronary risk to previous heart attack

Patients suffering from chronic kidney disease (CKD) could be at as high a risk of coronary heart disease as patients who have previously had a myocardial infarction (MI), according to an article published online recently in The Lancet.1

While it has long been established that patients with CKD are at higher risk of MI, the new study is the first large-scale, long-term study to examine whether kidney disease should be considered to be equivalent to having previously suffered an MI, in terms of the risk of future coronary events.

Lead researcher Dr Marcello Tonelli (University of Alberta), said: “Our research suggests that there is a strong case for considering CKD to be a coronary heart disease risk equivalent, meaning that people with CKD are at a comparable risk of coronary events to those who have previously had a heart attack”.

“Chronic kidney disease patients have substantially higher rates of death from heart disease after a heart attack than the general population, which emphasises the potential value of preventing coronary events through drug treatment and lifestyle interventions. In fact, the rate of death from heart disease among people with chronic kidney disease was similar to or higher than the rate of death among people with diabetes – in whom the value of preventive treatments is well known.”

Dr Paul Kalra

Dr Paul Kalra

The study examined records from almost 1.3 million patients in Canada, comparing the incidence of MI and death in patients with chronic kidney disease, diabetes, at least one previous MI, or a combination of these risk factors.   The researchers found that people with chronic kidney disease, diabetes, or both, tended to experience a comparable risk of MI to those who had previously had one, suggesting that kidney disease could prove to be a useful prognostic marker for coronary heart disease.

In an accompanying comment, George Bakris (University of Chicago) urges caution in the interpretation of the results, suggesting that although the study’s large scale is an advantage, a lack of information about individuals’ medication and other factors such as blood pressure means that the findings don’t necessarily provide clear-cut support for the classification of CKD as a coronary heart disease risk equivalent.

Professor Bakris states: “Tonelli and colleagues offer new insight by comparing individuals with chronic kidney disease with those who have a history of heart attack, on a very large scale. Their findings emphasise the importance of primary prevention, particularly because patients with chronic kidney disease comprise a large proportion of patients who have heart attack”.

On behalf of the Cardiorenal Forum, an independent UK group formed to highlight the clinical overlap between primary cardiovascular and renal problems, Dr Paul Kalra (Consultant cardiologist, Portsmouth Hospitals NHS Trust), commented to BJC Arrhythmia Watch:

“This interesting study from Tonelli and colleagues yet again highlights close links between the kidney and the heart in terms of cardiovascular disease risk and prognosis. We still have much to learn about the precise pathophysiological mechanisms involved and the optimal way of improving outcomes for such patients.”

“Many different pathways are now under evaluation and there is also interest in the use of biomarkers to identify those at most risk. Ensuring cardiologists and nephrologists work collaboratively on these ventures is fundamental to improving outcomes for these high risk patients”.

The 7th Annual Scientific Meeting of the Cardiorenal Forum will take place in London on Friday, 5th October 2012.  For more information, please visit http://www.cardiorenalforum.com/

References

1. Tonelli M, Muntner P, Lloyd A, et al. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet 2012.  http://dx.doi.org/10.1016/S0140-6736(12)60572-8/

2. Polonsky TS, Bakris GL. Chronic kidney disease: a coronary heart disease equivalent? Lancet 2012. http://dx.doi.org/10.1016/S0140-6736(12)60772-7/

Published on: July 24, 2012

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