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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAn estimated 26 million American adults have chronic kidney disease (CKD) and millions of others are at increased risk for CKD [National Kidney Foundation]. Furthermore, as glomerular filtration rate falls, the risk of cardiovascular death increases [Go AS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2004].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAn estimated 26 million American adults have chronic kidney disease (CKD) and millions of others are at increased risk for CKD [National Kidney Foundation. \u003Ca href=\u0022http:\/\/www.kidney.org\u0022\u003Ewww.kidney.org\u003C\/a\u003E]. Furthermore, as glomerular filtration rate falls, the risk of cardiovascular (CV) death increases [Go AS et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2004].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ERobert P. Giugliano, MD, SM, Harvard Medical School, Boston, Massachusetts, USA, reviewed the overlap of CKD and CV risk, highlighted results of key clinical trials and guideline recommendations in patients with CKD and CV disease (CVD), and discussed potential future therapies in this group of patients.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EAccording to Dr. Giugliano, the strong association between CKD and CVD is underappreciated. Patients with CKD have a higher prevalence of both traditional CVD risk factors (eg, hypertension, type 2 diabetes, and dyslipidemia) as well as nontraditional ones, (eg, inflammation, malnutrition, mineral disorders, and anemia). \u201cAll patients with CKD, even those with mild-to-moderate renal dysfunction, should be considered at high risk for CV death,\u201d he said, noting an inverse exponential relationship between the 2 diseases.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAn overlap of 3 common diseases\u2014diabetes mellitus, hyperlipidemia, and CKD\u2013can help explain why these patients are at hightened risk and point towards common solutions (Figure 1). In 2011, 366 million people worldwide had diabetes; 183 million (50%) were undiagnosed [IDF Diabetes Atlas. The Global Burden \u003Ca href=\u0022http:\/\/www.idf.org\u0022\u003Ewww.idf.org\u003C\/a\u003E]. Patients with type 2 diabetes make up the largest and fastest growing single disease group requiring renal replacement therapy [Vora JP et al. \u003Cem\u003EJ Hum Hypertens\u003C\/em\u003E 2000]. The Hypertension Detection and Follow-up Program [Shulman NB et al. \u003Cem\u003EHypertension\u003C\/em\u003E 1989] found that in CKD patients with creatinine \u0026gt;1.7 mg\/dL, 58% died from CVD and 19% from renal failure. General treatment principles at that time included the evaluation and aggressive treatment of CVD risk factors and the assessment of CKD-related factors (eg, proteinuria, anemia, and volume status).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe lipid profile typically seen in renal disease is characterized by high circulating triglycerides, very low-density lipoprotein cholesterol, intermediate-density lipoprotein, cholesterol, chylomicron remnants, low plasma high-density lipoprotein cholesterol particles, and increased levels of lipoprotein A. Numerous studies have shown that lipid derangement is likely to be an independent risk factor for the development of renal disease [Gyebi L et al. \u003Cem\u003ECurr Hypertens Rep\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EStatin administration in CKD is now common practice endorsed by the Kidney Disease Outcomes Quality Initiative (KDOQI) [Ruan XZ et al. \u003Cem\u003ENat Rev Nephrol\u003C\/em\u003E 2009; Gyebi L et al. \u003Cem\u003ECurr Hypertens Rep\u003C\/em\u003E 2012]. Subgroup analyses in patients with CKD from prior statin studies demonstrated that the benefits of statin therapy extended to patients with CKD. Indeed, there was a 14.5% decline in total mortality (p=0.045) in the Pravastatin Pooling Project [Tonelli M et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004]. The landmark Study of Heart and Renal Protection [SHARP] trial found that reduction of LDL cholesterol with simvastatin 20 mg in combination with ezetimibe 10 mg daily safely reduced the incidence of major atherosclerotic events in a wide range of patients with advanced CKD, including those managed with dialysis as well as patients not requiring dialysis [Baigent C et al. \u003Cem\u003ELancet\u003C\/em\u003E 2011] (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/24\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Reduced LDL Cholesterol Cut the Incidence of Major Atherosclerotic Events in Advanced CKD Patients.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-314729431\u0022 data-figure-caption=\u0022Reduced LDL Cholesterol Cut the Incidence of Major Atherosclerotic Events in Advanced CKD Patients.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/24\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/24\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/12\/24\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12868\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EReduced LDL Cholesterol Cut the Incidence of Major Atherosclerotic Events in Advanced CKD Patients.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ELDL=low-density lipoprotein.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReprinted with permission from The \u003Cem\u003ELancet\u003C\/em\u003E 2011. Baigent C et al. The effects of lowering cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EFuture research will focus on reducing the risk of acute renal failure, defining optimal revascularization and reperfusion strategies, reducing bleeding, and the assessment and treatment of nontraditional CKD-related risk factors (eg, anemia, brain natriuretic peptide, parathyroid hormone, calcium, phosphorus, homocysteine, inflammation, thrombotic factors, and oxidative stress).\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/12\/24.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzncnq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzncnq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}