Prevention of Cardiovascular Events in Patients With Chronic Kidney Disease

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Pharmacology

Background:

• Chronic kidney disease (CKD) significantly elevates the risk of major adverse cardiovascular events (MACE), including myocardial infarction, stroke, heart failure, and cardiovascular death.
• Historically, cardiovascular outcome studies have underrepresented CKD patients, limiting evidence-based intervention strategies.
• Recent advancements have introduced specific pharmacologic agents demonstrating cardiovascular benefits in this high-risk population.

Purpose of the Study:

• To systematically review the evidence for lifestyle and pharmacologic interventions aimed at reducing cardiovascular events in patients with CKD.
• To analyze the efficacy of these interventions across distinct CKD patient subtypes.
• To highlight the current evidence base for managing cardiovascular risk in CKD.

Main Methods:

• A comprehensive literature search of PubMed was conducted from inception to February 2023.
• References from selected studies were reviewed to identify additional relevant articles.
• Inclusion criteria focused on English-language studies reporting cardiovascular outcomes in CKD patients.

Main Results:

• Evidence for many interventions is derived from observational studies or subgroup analyses.
• Some interventions, like weight loss, may pose risks in certain CKD patients.
• Newer agents, including SGLT2 inhibitors and finerenone, demonstrate clearer cardiovascular benefits, often within specific subgroups (e.g., those with albuminuria).

Conclusions:

• Understanding effective interventions is crucial given the high cardiovascular burden in CKD.
• While some traditional recommendations require careful consideration, newer pharmacotherapies offer significant promise.
• Tailoring interventions based on CKD subtype and individual patient characteristics is essential for optimizing cardiovascular outcomes.