RESUMO
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, and its prevalence is increasing worldwide. Statins are the mainstay of treatment but do not address all aspects of CVD risk. Other lipid-lowering therapies are available but are less effective than statins. New therapies to lower low-density-lipoprotein cholesterol (LDL-C) by as much as statins, to reduce triglycerides (TGs), and to modify the metabolism of high-density lipoproteins (HDLs) are in development.
Assuntos
Anticolesterolemiantes/uso terapêutico , Anticorpos Monoclonais/farmacologia , Ácidos e Sais Biliares/metabolismo , Doenças Cardiovasculares/prevenção & controle , Proteínas de Transporte/antagonistas & inibidores , Proteínas de Transferência de Ésteres de Colesterol/antagonistas & inibidores , LDL-Colesterol/metabolismo , Ácidos Fíbricos/uso terapêutico , Terapia Genética , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipoproteínas HDL/metabolismo , Oligonucleotídeos Antissenso/uso terapêutico , Receptores Ativados por Proliferador de Peroxissomo/agonistas , Pró-Proteína Convertase 9 , Pró-Proteína Convertases/antagonistas & inibidores , Pró-Proteína Convertases/genética , Serina Endopeptidases/genética , Triglicerídeos/metabolismoRESUMO
Chronic kidney disease (CKD) affects around 10-13% of the general population, with only a small proportion in end stage renal disease (ESRD), either on dialysis or awaiting renal transplantation. It is well documented that CKD patients have an extremely high risk of developing cardiovascular disease (CVD) compared with the general population, so much so that in the early stages of CKD patients are more likely to develop CVD than they are to progress to ESRD. Various pathophysiological pathways and explanations have been advanced and suggested to account for this, including endothelial dysfunction, dyslipidaemia, inflammation, left ventricular hypertrophy and cardiac autonomic dysfunction. In this review, we try to understand and further explore the link between CKD and CVD, as well as offering interventional advice where available, while exposing the current lack of RCT-based research and trial evidence in this area. We also suggest pragmatic Interim measures we could take while we wait for definitive RCTs.