Peev Vasil, Nayer Ali, Contreras Gabriel
University of Miami Miller School of Medicine, Miami, Florida, USA.
Curr Opin Lipidol. 2014 Feb;25(1):54-60. doi: 10.1097/MOL.0000000000000045.
Dyslipidemia, malnutrition and inflammation are common in patients with chronic kidney disease (CKD) and are strongly associated with cardiovascular disease (CVD) and increased mortality. The epidemiology of dyslipidemia and its interactions with malnutrition and inflammation in CKD patients have been the subject of much interest in the past decade. Recent clinical trials have explored the effects of statins on CVD specifically in CKD patients.
Whereas the risk relationship between total cholesterol level and CVD morbidity and mortality is direct, strong and progressive in CKD patients without malnutrition and inflammation, it is inconsistent and often paradoxical in those with malnutrition and inflammation. Accumulating evidence demonstrates that statins reduce significantly the risk of CVD in CKD patients before the initiation of dialysis. However, the beneficial effect of statins in CKD patients on dialysis is uncertain. In CKD patients on dialysis, malnutrition and inflammation pose a higher risk for CVD than dyslipidemia.
In CKD patients, the risk of CVD associated to dyslipidemia is complex and is modified by malnutrition and inflammation.
血脂异常、营养不良和炎症在慢性肾脏病（CKD）患者中很常见，并且与心血管疾病（CVD）及死亡率增加密切相关。过去十年间，CKD患者血脂异常的流行病学及其与营养不良和炎症的相互作用一直是备受关注的话题。近期的临床试验专门探讨了他汀类药物对CKD患者心血管疾病的影响。
在没有营养不良和炎症的CKD患者中，总胆固醇水平与心血管疾病发病率和死亡率之间的风险关系是直接、强烈且呈渐进性的，而在伴有营养不良和炎症的患者中，这种关系并不一致，且常常自相矛盾。越来越多的证据表明，在开始透析前，他汀类药物可显著降低CKD患者发生心血管疾病的风险。然而，他汀类药物对透析的CKD患者的有益作用尚不确定。在透析的CKD患者中，营养不良和炎症比血脂异常对心血管疾病构成的风险更高。
在CKD患者中，与血脂异常相关的心血管疾病风险是复杂的，且会受到营养不良和炎症的影响。
