People suffering from a chronic kidney disease have an increased risk of also experiencing a heart attack and as such, they need to keep their level of cholesterol under observation. After reviewing the two sets of guidelines regarding cholesterol management, researchers seem to agree that all patients with pre-dialysis kidney disease should take statins.
First of all, statins are a class of drugs that lower blood cholesterol by blocking the action of a liver enzyme, however, this is not their only effect. Dr. Komaroff, physician and professor at Harvard Medical School explains:
“Heart attacks occur when cholesterol-filled plaques in the heart’s arteries rupture, causing a clot that blocks blood from getting to the heart. These ruptures are caused by inflammations inside the plaques and statins reduce inflammation.”
The Centers for Disease Control and Prevention (CDC) estimates that 10% of the American adult population may be suffering of chronic kidney disease(CKD), which means that over 20 million people have an increased risk of cardiovascular disease and heart attacks. As a study published in the Journal of the American Society of Nephrology showed, 50% of them do not take their cholesterol-lowering medication.
Last year, two sets of guidelines regarding the management of cholesterol were published: one by the American College of Cardiology/American Heart Association (ACC/AHA) and the other by the Kidney Disease Improving Global Outcomes Lipid Work Group (KDIGO). The ACC/AHA guideline recommends statin treatment for individuals that have diabetes, high cholesterol, a history of heart attack or a calculated 10-year risk of at least 7.5% using the “Pooled Cohorts risk equations” formula, while the KDIGO guideline states that statin therapy is recommended for all individuals aged 50-79, that suffer from CKD.
Dr. Lisandro Colantonio, of the University of Alabama at Birmingham School of Public Health and his colleagues investigated the difference in impact the two guidelines would have upon patients, using for the analysis 4,726 CKD patients, aged 50-79 years.
They discovered that 100% of patients were recommended statin treatment according to KDIGO guidelines, while the ACC/AHA guidelines advised 92% of the patients to start statin therapy. Moreover, they found that the “Pooled Cohorts risk equations” formula is a trustworthy tool in estimating heart disease risk.
Dr. Colantonio concluded that both guidelines can be a starting point for the implementation of statin therapy for CKD patients, aged 50-79 years. What is more, the initiation of statin therapy should be considered a high priority.