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Risk factors for coronary artery disease in patients with renal failure
1Nephrology Division, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada. sarah.prichard@muhc.mcgill.ca
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Patients with end-stage renal disease (ESRD) face significantly higher cardiovascular mortality, primarily due to coronary artery disease. Traditional and nontraditional risk factors are prevalent, but their modification
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Patients with end-stage renal disease (ESRD) exhibit markedly increased cardiovascular mortality.
- Coronary artery disease is the leading cause of death in ESRD patients, especially those on dialysis.
Purpose of the Study:
- To review cardiovascular risk factors in patients with ESRD.
- To discuss the impact of traditional and nontraditional risk factors on cardiovascular outcomes in ESRD.
Main Methods:
- Literature review of cardiovascular risk factors in ESRD.
- Analysis of traditional risk factors (age, gender, hypertension, diabetes, dyslipidemia).
- Examination of nontraditional risk factors (hyperhomocystinemia, inflammation, calcium x phosphate product, endothelial dysfunction, oxidant stress).
Main Results:
- ESRD patients have a high prevalence of traditional cardiovascular risk factors, exacerbated by the disease.
- Nontraditional risk factors are frequently observed in ESRD patients.
- The effectiveness of modifying these risk factors in ESRD patients is not yet certain.
Conclusions:
- Cardiovascular disease is a major concern for ESRD patients.
- Both traditional and nontraditional risk factors contribute significantly to cardiovascular mortality in ESRD.
- Further research is needed to determine the impact of risk factor modification in this population.
Abstract:
Cardiovascular mortality is markedly increased in patients with end-stage renal disease (ESRD), particularly those receiving dialysis. Coronary artery disease is the most important cause of death in these patients. As in the general population, older age, male gender, and the postmenopausal state in women are cardiovascular risk factors in patients with ESRD. However, hypertension, diabetes mellitus, and dyslipidemia, known to promote cardiovascular disease in the general population, are particularly likely to do so in patients with ESRD because of their high prevalence in this population. In addition, nontraditional cardiovascular risk factors, such as hyperhomocystinemia, inflammation, elevated calcium x phosphate product, endothelial dysfunction, and oxidant stress, occur frequently in patients with ESRD. Vigorous treatment of modifiable cardiovascular risk factors has reduced cardiovascular risk in patients without ESRD. The extent to which such risk factor modification would alter cardiovascular risk in ESRD remains uncertain.