Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
3rd Department of Internal Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 499/2, 128 08, Prague, Czech Republic.
Curr Atheroscler Rep. 2024 Apr;26(4):103-109. doi: 10.1007/s11883-024-01191-w. Epub 2024 Jan 30.
Chronic kidney disease (CKD) is associated with a significantly increased risk of cardiovascular disease (CVD). This review summarizes known risk factors, pathophysiological mechanisms, and current therapeutic possibilities, focusing on lipid-lowering therapy in CKD.
Novel data on lipid-lowering therapy in CKD mainly stem from clinical trials and clinical studies. In addition to traditional CVD risk factors, patients with CKD often present with non-traditional risk factors that include, e.g., anemia, proteinuria, or calcium-phosphate imbalance. Dyslipidemia remains an important contributing CVD risk factor in CKD, although the mechanisms involved differ from the general population. While statins are the most commonly used lipid-lowering therapy in CKD patients, some statins may require dose reduction. Importantly, statins showed diminished beneficial effect on cardiovascular events in patients with severe CKD and hypercholesterolemia despite high CVD risk and effective reduction of LDL cholesterol. Ezetimibe enables the reduction of the dose of statins and their putative toxicity and, in combination with statins, reduces CVD endpoints in CKD patients. The use of novel drugs such as PCSK9 inhibitors is safe in CKD, but their potential to reduce cardiovascular events in CKD needs to be elucidated in future studies.
慢性肾脏病（CKD）与心血管疾病（CVD）风险显著增加相关。本综述重点介绍了 CKD 患者的调脂治疗，总结了已知的危险因素、病理生理机制和目前的治疗可能性。
CKD 调脂治疗的新数据主要来源于临床试验和临床研究。除了传统的 CVD 危险因素外，CKD 患者还常伴有非传统危险因素，如贫血、蛋白尿或钙磷失衡。尽管涉及的机制与普通人群不同，但血脂异常仍然是 CKD 患者发生 CVD 的重要危险因素。他汀类药物是 CKD 患者最常用的调脂药物，但某些他汀类药物可能需要减少剂量。重要的是，尽管他汀类药物能有效降低 LDL 胆固醇，但在严重 CKD 和高胆固醇血症患者中，他汀类药物对心血管事件的有益作用减弱。依折麦布可减少他汀类药物的剂量及其潜在毒性，与他汀类药物联合使用可降低 CKD 患者的心血管终点。PCSK9 抑制剂等新型药物在 CKD 中的应用是安全的，但它们在 CKD 中降低心血管事件的潜力需要在未来的研究中阐明。
