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Primary and Secondary Prevention of Cardiovascular Disease in Patients with Chronic Kidney Disease

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Non-dialysis-dependent chronic kidney disease (NDD-CKD) patients are at an increased risk of cardiovascular disease (CVD)–related deaths in comparison with the general population. This review summarizes recent guideline recommendations and studies on primary and secondary prevention of traditional cardiovascular (CV) risk factors in those with NDD-CKD.

Recent Findings

The use of antiplatelet agents for primary prevention in CKD is not supported by clinical trial evidence; however, they offer potential benefits when used for secondary prevention of CVD in the absence of an elevated bleeding risk. Lipid-lowering therapy reduces CV risk and is recommended for all NDD-CKD patients. In light of recent clinical trial findings, current clinical practice guidelines recommend a blood pressure (BP) goal < 130/80 mmHg and support the use of renin-angiotensin-aldosterone system inhibitors. Evidence supporting intensive glycemic control is limited in those with diabetes and CKD. Newer oral glycemic agents such as sodium-glucose co-transporter type 2 (SGLT2) inhibitors and glucagon-like-peptide-1 (GLP-1) receptor agonists reduce urinary albumin excretion, slow kidney disease progression, and reduce CV events. Despite the absence of dedicated clinical trials in the CKD population, lifestyle modifications including smoking cessation, intentional weight loss, and regular physical activity should be recommended to those with CKD.

Summary

Patients with NDD-CKD should be treated with statins and a BP target of 130/80 mmHg should be aimed for. Limited data exists for interventions targeting other CV risk factors in CKD patients. Future studies examining the impact of various interventions targeting different primary and secondary CV prevention strategies are needed to fill knowledge gaps and improve CV outcomes.

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Sources of Support

Dr. Navaneethan is supported by a grant from the National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Disease-R01DK101500).

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Author notes

  1. Sehrish Ali and Natasha Dave contributed equally to this work.

Authors and Affiliations

  1. Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Suite 100-37D, Houston, TX, 77030, USA

    Sehrish Ali, Natasha Dave & Sankar D. Navaneethan

  2. Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Natasha Dave & Sankar D. Navaneethan

  3. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Salim S. Virani

  4. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Salim S. Virani

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  1. Sehrish Ali
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Correspondence to Sankar D. Navaneethan.

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Conflict of Interest

The authors report no relevant financial interest in the contents of this review. Outside the submitted work, S.D.N. has served on the event adjudication committee for clinical trials sponsored by Bayer and Boehringer Ingelheim, served as a consultant for Tricida, and has received investigator-initiated research support from Keryx Pharmaceuticals.

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Ali, S., Dave, N., Virani, S.S. et al. Primary and Secondary Prevention of Cardiovascular Disease in Patients with Chronic Kidney Disease. Curr Atheroscler Rep 21, 32 (2019). https://doi.org/10.1007/s11883-019-0794-6

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