Excess cardiovascular risks in chronic kidney disease (CKD) patients may be due to dysfunctional high-density lipoprotein (HDL), suggest the authors of a recent review article in the Archives of Medical Research.
Despite statin therapy and treatments that raise HDL levels, CKD patients still experience increased risks that can lead to coronary artery disease (CAD), arrhythmias, heart failure, stroke, and early mortality. The current Framingham risk prediction formula grossly underestimates cardiovascular disease (CVD) risks in this population, the investigators pointed out. The American College of Cardiology, the American Heart Association, and the National Kidney Foundation all recommend that CKD be considered equivalent to CAD as a predictor of cardiovascular events in these patients.
Accumulating evidence suggests that CKD affects HDL composition and metabolism in several ways: “CKD, particularly in advanced stages, disrupts the ability of HDL to extract cellular cholesterol, control inflammation and oxidation, and protect the endothelium, likely contributing to the exaggerated rate of CVD in renal patients,” stated Valentina Kon, MD, of Vanderbilt University Medical Center in Nashville, and colleagues.
Raising HDL and lowering low-density lipoprotein levels seem to have little impact on CVD risk in patients. The researchers suggest that new therapies to correct HDL function may be more useful.