Division of Nephrology, Department of Medicine, WJB Dorn VA Medical Center, Columbia, South Carolina, USA.
Division of Cardiology, New York University School of Medicine, New York, New York, USA.
Kidney Int. 2017 Apr;91(4):797-807. doi: 10.1016/j.kint.2016.09.049. Epub 2016 Dec 28.
Patients with chronic kidney disease (CKD) have a high prevalence of atherosclerotic cardiovascular disease, likely reflecting the presence of traditional risk factors. A greater distinguishing feature of atherosclerotic cardiovascular disease in CKD is the severity of the disease, which is reflective of an increase in inflammatory mediators and vascular calcification secondary to hyperparathyroidism of renal origin that are unique to patients with CKD. Additional components of atherosclerotic cardiovascular disease that are prominent in patients with CKD include microvascular disease and myocardial fibrosis. Therapeutic interventions that minimize cardiovascular events related to atherosclerotic cardiovascular disease in patients with CKD, as determined by well-designed clinical trials, are limited to statins. Data are lacking regarding other available therapeutic measures primarily due to exclusion of patients with CKD from major trials studying cardiovascular disease. Data from well-designed randomized controlled trials are needed to guide clinicians who care for this high-risk population in the management of atherosclerotic cardiovascular disease to improve clinical outcomes.
患有慢性肾脏病（CKD）的患者易患动脉粥样硬化性心血管疾病，这可能反映出存在传统的风险因素。CKD 患者动脉粥样硬化性心血管疾病的一个更显著特征是疾病的严重程度，这反映了肾源性甲状旁腺功能亢进引起的炎症介质和血管钙化的增加，这些都是 CKD 患者所特有的。在 CKD 患者中突出的动脉粥样硬化性心血管疾病的其他组成部分包括微血管疾病和心肌纤维化。通过精心设计的临床试验确定的、可最大限度减少与 CKD 患者动脉粥样硬化性心血管疾病相关的心血管事件的治疗干预措施仅限于他汀类药物。由于主要的心血管疾病研究排除了 CKD 患者，因此缺乏其他可用治疗措施的数据。需要来自精心设计的随机对照试验的数据来指导治疗此类高危人群的临床医生管理动脉粥样硬化性心血管疾病，以改善临床结果。
