Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

HSR&D Citation Abstracts

Search | Search by Center | Search by Source | Keywords in Title

Ali S, Dave N, Virani SS, Navaneethan SD. Primary and Secondary Prevention of Cardiovascular Disease in Patients with Chronic Kidney Disease. Current Atherosclerosis Reports. 2019 Jun 22; 21(9):32.
PubMed logo Search for Abstract from PubMed
(This link leaves the website of VA HSR&D.)


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. 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.