The contribution of early nephropathy to cardiovascular risk

Patients with an estimated glomerular filtration rate (eGFR) of less than 60 mL/min per 1.72 m(2), and presence of microalbuminuria (MA), have an increased risk of cardiovascular (CV) events, compared with patients with normal renal function. The strength of the association among patients with a mild reduction in eGFR depends largely on the population studied, whereas the data regarding MA show an elevated risk among both low- and high-risk populations. Patients with mildly reduced eGFR or MA experience a reduction in CV events and progression of renal disease with treatment of CV risk factors. For patients who experience a myocardial infarction, observational data suggest that patients with a mildly reduced eGFR also have improved outcomes with an early invasive strategy, compared with a noninvasive strategy. However, whether targeting therapy to normalize renal function also confers a reduction in CV events remains unknown.