Chronic Kidney Disease as a Coronary Heart Disease Risk Equivalent
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Chronic Kidney Disease as a Coronary Heart Disease Risk Equivalent Paul Muntner & Michael E. Farkouh
Published online: 12 March 2010 # Springer Science+Business Media, LLC 2010
Abstract Tailoring therapeutic targets to patients’ risk is a fundamental principle of many coronary heart disease (CHD) treatment guidelines. Although the National Cholesterol Education Program’s guidelines do not include chronic kidney disease (CKD) as a CHD risk equivalent, the National Kidney Foundation and American Heart Association have recommended its inclusion in the highest-risk grouping for the prevention and treatment of cardiovascular disease. In three population-based studies, the risk of cardiovascular disease was higher among participants with established CHD when compared to their counterparts with CKD. Although there are other reasons for including CKD as a CHD risk equivalent in treatment guidelines (eg, higher case fatality rates from CHD and stroke), the inclusion of CKD as a CHD risk equivalent has treatment implications for a large number of US adults. Randomized trials assessing the benefits and drawbacks of aggressive CHD risk reduction among patients with CKD are needed. Keywords Chronic kidney disease . Coronary heart disease . Treatment guidelines . Risk factor
P. Muntner Department of Epidemiology, University of Alabama at Birmingham, 1655 University Boulevard, Suite 220, Birmingham, AL 35294, USA P. Muntner (*) Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA e-mail: [email protected] M. E. Farkouh Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
Introduction A lower therapeutic target in patients with increased risk of events is a fundamental principle of many coronary heart disease (CHD) treatment guidelines. For example, in the National Cholesterol Education Program’s (NCEP) Adult Treatment Panel III (ATP III) guidelines, patients with low CHD risk are recommended treatment to a low-density lipoprotein (LDL) cholesterol less than 160 mg/dL, whereas patients with established CHD or acute coronary syndromes are recommended treatment to a target LDL cholesterol level less than 100 mg/dL, with an option to treat to less than 70 mg/dL [1, 2]. Additionally, individuals with certain medical conditions and/or a high CHD risk (eg, > 20% 10-year risk of CHD) but without a history of CHD are considered to have “CHD equivalents” and recommended the same treatment target (ie, LDL cholesterol < 100 mg/dL with an optional goal 20%)
CHD coronary heart disease. a
See Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) [1] for an explanation of CHD and risk equivalents.
1.73 m2 (stage 3 to 5 CKD) or albuminuria (eg, urine albumin to creatinine ratio≥30 mg/g), is not included as a CHD risk equivalent in the ATP III guidelines [1]. Recent estimates indicate 26 million adults in the United St
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