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Increased Cardiovascular Risk in Young Patients with CKD and the Role of Lipid-Lowering Therapy

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Abstract

Purpose of Review

Chronic kidney disease (CKD) is associated with a significantly increased risk of cardiovascular disease (CVD). This review summarizes known risk factors, pathophysiological mechanisms, and current therapeutic possibilities, focusing on lipid-lowering therapy in CKD.

Recent Findings

Novel data on lipid-lowering therapy in CKD mainly stem from clinical trials and clinical studies.

Summary

In addition to traditional CVD risk factors, patients with CKD often present with non-traditional risk factors that include, e.g., anemia, proteinuria, or calcium-phosphate imbalance. Dyslipidemia remains an important contributing CVD risk factor in CKD, although the mechanisms involved differ from the general population. While statins are the most commonly used lipid-lowering therapy in CKD patients, some statins may require dose reduction. Importantly, statins showed diminished beneficial effect on cardiovascular events in patients with severe CKD and hypercholesterolemia despite high CVD risk and effective reduction of LDL cholesterol. Ezetimibe enables the reduction of the dose of statins and their putative toxicity and, in combination with statins, reduces CVD endpoints in CKD patients. The use of novel drugs such as PCSK9 inhibitors is safe in CKD, but their potential to reduce cardiovascular events in CKD needs to be elucidated in future studies.

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Data Availability

No datasets were generated or analysed during the current study.

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Funding

The authors are supported by a grant from the Ministry of Health, Czech Republic, RVO (MH CZ-DRO-VFN64165).

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Authors and Affiliations

  1. Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic

    Vojtech Kratky, Zdenka Hruskova & Vladimir Tesar

  2. 3rd Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 499/2, 128 08, Prague, Czech Republic

    Anna Valerianova & Jan Malik

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VK and JM performed the literature review and prepared the manuscript. AV, ZH, and VT critically reviewed the article and provided suggestions and corrections. All authors contributed to the article and approved the submitted version.

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Correspondence to Zdenka Hruskova.

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Kratky, V., Valerianova, A., Hruskova, Z. et al. Increased Cardiovascular Risk in Young Patients with CKD and the Role of Lipid-Lowering Therapy. Curr Atheroscler Rep 26, 103–109 (2024). https://doi.org/10.1007/s11883-024-01191-w

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