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Abnormalities of kidney function as a cause and a consequence of cardiovascular disease
1Emory University School of Medicine, Atlanta, Georgia 30324, USA.
Insights
Hypertension, left ventricular hypertrophy, and kidney dysfunction indicators like hypercreatininemia and microalbuminuria are significant cardiovascular disease risks. Early heart failure involves impaired sodium handling, making salt intake crucial for management.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Hypertension, left ventricular hypertrophy (LVH), hypercreatininemia, and microalbuminuria (MA) are independent risk factors for cardiovascular disease (CVD).
- Hypertension elevates CVD risk 2-3 fold; concentric LVH predicts coronary heart disease, heart failure, stroke, and peripheral arterial disease.
- Elevated serum creatinine (≥1.7 mg/dL) in hypertensive individuals may be a stronger CVD risk factor than diabetes, smoking, LVH, or systolic blood pressure.
Purpose of the Study:
- To highlight the independent risk factors for cardiovascular disease (CVD).
- To emphasize the prognostic significance of hypercreatininemia and microalbuminuria in CVD.
- To discuss the role of renal sodium handling in early heart failure and its management.
Main Methods:
- Review of established risk factors for cardiovascular disease.
- Analysis of the predictive value of serum creatinine and microalbuminuria for CVD.
- Discussion of the pathophysiology of early heart failure related to sodium handling.
Main Results:
- Microalbuminuria (MA) is a potent predictor of CVD morbidity and mortality across various patient groups.
- Hypercreatininemia, particularly serum creatinine ≥1.7 mg/dL, signifies substantial CVD risk in hypertensive patients.
- Early heart failure is characterized by impaired renal sodium handling and is sensitive to salt balance.
Conclusions:
- Hypertension, LVH, hypercreatininemia, and MA are critical, independent CVD risk factors requiring vigilant management.
- Early detection and management of renal dysfunction markers are crucial for cardiovascular risk stratification.
- Therapeutic strategies for heart failure should address sodium retention and neurohumoral activation.
Abstract:
Hypertension, left ventricular hypertrophy (LVH), hypercreatininemia, and microalbuminuria (MA) are independent risk factors for cardiovascular disease (CVD). Hypertension increases the risk of CVD by two- to three-fold and LVH (especially concentric) is a risk factor for coronary heart disease, heart failure, stroke, and peripheral arterial disease. In people with hypertension, a serum creatinine level of 1.7 mg/dL or more may be an even stronger CVD risk factor than diabetes, smoking, LVH, or systolic blood pressure. Similarly, MA is a strong and independent predictor of CVD morbidity and mortality in people with and without diabetes and/or hypertension. Impaired renal sodium handling and sodium retention are physiological hallmarks of the very early stages of heart failure. Heart failure is a physiologically delicate condition that can decompensate with excess dietary salt intake or over diuresis, or compensate with cautious therapy designed to block the sodium retention and simultaneously interrupt excessively activated neurohumoral mechanisms.