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The cholesterol paradox is flawed; cholesterol must be lowered in dialysis patients

Ray K Wan1, Patrick B Mark, Alan G Jardine

  • 1BHF Cardiovascular Research Centre, University of Glasgow, and Renal Transplant Unit, Western Infirmary, Glasgow, United Kingdom.

Seminars in Dialysis
|November 10, 2007
PubMed

Insights

In patients with chronic kidney disease, the link between cholesterol and heart disease is complex. However, cholesterol lowering is still likely effective for improving cardiovascular outcomes.

Area of Science:

  • Nephrology
  • Cardiology
  • Biochemistry

Background:

  • Elevated cholesterol is linked to cardiovascular disease (CVD) and mortality in the general population.
  • The relationship between serum lipids and CVD outcomes is less clear and potentially reversed in patients with renal disease.
  • Factors like co-morbidities, malnutrition, inflammation, and atypical dyslipidemia complicate the cholesterol-CVD link in renal disease.

Purpose of the Study:

  • To clarify the complex relationship between cholesterol and cardiovascular disease in patients with chronic kidney disease (CKD).
  • To opine on the effectiveness of cholesterol lowering in the CKD population despite confounding factors.

Main Methods:

  • Review and synthesis of existing literature on lipid profiles and cardiovascular outcomes in general and renal populations.
  • Analysis of factors that may obscure the relationship between cholesterol and coronary artery disease in CKD patients.

Main Results:

  • The typical presentation of cardiovascular disease in renal patients is not myocardial infarction.
  • The relationship between cholesterol and coronary disease is obscured by several co-existing conditions in CKD.

Conclusions:

  • Despite the complexities, cholesterol lowering is expected to remain effective in patients with chronic kidney disease.
  • Further research may be needed to fully elucidate the mechanisms and optimize lipid management strategies in CKD.

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