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Lipid, Blood Pressure and Kidney Update 2013

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Lipid, Blood Pressure and Kidney Update 2013 Int Urol Nephrol DOI 10.1007/s11255-014-0657-6 NEPHROLOGY - REVIEW Lipid, blood pressure and kidney update 2013 Maciej Banach • Corina Serban • Wilbert S. Aronow • Jacek Rysz • Simona Dragan • Edgar V. Lerma • Mugurel Apetrii • Adrian Covic Received: 11 November 2013 / Accepted: 28 January 2014 Ó The Author(s) 2014. This article is published with open access at Springerlink.com Abstract The year 2013 proved to be very exciting as far Society of Hypertension/International Society of Hyper- as landmark trials and new guidelines in the field of lipid tension Clinical Practice Guidelines for the Management of disorders, blood pressure and kidney diseases. Among Hypertension in the Community, the American College of these are the International Atherosclerosis Society Global Physicians Clinical Practice Guideline on Screening, Recommendations for the Management of Dyslipidemia, Monitoring, and Treatment of Stage 1–3 CKD and many European Society of Cardiology (ESC)/European Society important trials presented among others during the ESC of Hypertension Guidelines for the Management of Arterial Annual Congress in Amsterdam and the American Society Hypertension, American Diabetes Association Clinical of Nephrology Annual Meeting—Kidney Week in Atlanta, Practice Recommendations, the Kidney Disease: Improv- GA. The paper is an attempt to summarize the most ing Global Outcomes Clinical Practice Guidelines for important events and reports in the mentioned areas in the Managing Dyslipidemias in Chronic Kidney Disease passing year. (CKD) Patients, the American College of Cardiology/ American Heart Association Guideline on the Treatment of Keywords Anemia Á Blood pressure Á Cholesterol Á Blood Cholesterol to Reduce Atherosclerotic Cardiovas- Dyslipidemia Á Hypertension Á Lipids Á Renal disease Á cular Risk in Adults, the Joint National Committee Expert Transplantation Panel (JNC 8) Evidence-Based Guideline for the Man- agement of High Blood Pressure in Adults, the American M. Banach (&) S. Dragan Department of Hypertension, Chair of Nephrology Cardiology Department, University of Medicine and Pharmacy and Hypertension, Medical University of Lodz, ‘‘Victor Babes’’ Timisoara, Timisoara, Romania Zeromskiego 113, 90-549 Lodz, Poland e-mail: [email protected] E. V. Lerma Section of Nephrology, University of Illinois at Chicago, C. Serban Chicago, IL, USA Department of Functional Sciences, Chair of Pathophysiology, ‘‘Victor Babes’’ University of Medicine and Pharmacy M. Apetrii Á A. Covic of Timisoara, Timisoara, Romania Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital, Iasi, Romania W. S. Aronow Cardiology Division, New York Medical College, M. Apetrii Á A. Covic Valhalla NY, USA Grigore. T. Popa University of Medicine and Pharmacy, Iasi, Romania J. Rysz Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland 123 Int Urol Nephrol Lipid update 2013 assessment tools have also been recommended to com- plement the guidelines when embarking on the decision LDL cholesterol and coronary risk whether or not to start patients on statins [5]. The large debate has started since the publishing of the In patients with multiple cardiovascular (CV) risk factors, it new lipid guidelines. In the same month, the National Lipid is essential to effectively manage the overall risk, in order to Association (NLA) released a position statement express- prevent CV events [1]. Traditionally, low-density lipopro- ing opposition to the former’s recommendation to remove tein cholesterol (LDL-C) and high-density lipoprotein cho- LDL-C (and non-HDL-C) treatment targets [6]. Also lesterol (HDL-C) have been considered as the classical European Atherosclerotic Society (EAS) distanced from biomarkers of risk assessment as well as the therapeutic new ACC/AHA guidelines [7]. The European experts targets in both primary and secondary prevention. indicate that in the new American guidelines, statin treat- It is worth emphasizing that the current European ment is recommended for primary prevention in subjects Society of Cardiology (ESC)/European Atherosclerosis with a risk of ASCVD event of 7.5 %, irrespective of LDL- Society (EAS) guidelines (2011) indicate LDL-C as an C level, which would correspond to a moderate—2.5 % only target for lipid disorders therapy [2]. Previous clas- risk of CVD death in 10 years according to the European sification schemes and treatment levels for hyperlipidemia SCORE model. Therefore, they suggest that the impact of have been based on the National Cholesterol Education the ACC/AHA strategy should be put into the perspective Panel’s Adult Treatment Program-3 (ATP-III) guidelines. of the very large number of subjects in the population who Interestingly, in November 2013, the Kidney Disease: would be eligible for lifelong statin treatment from the age Improving Global Outcomes (KDIGO) published a new of 40 years onwards [7]. They also comment a new risk evidence-based Clinical Practice Guideline making rec- estimation model for estimating the total CVD risk (Pool ommendations on treatment of dyslipidemias in chronic cohorts equations) that has been developed in the new kidney disease (CKD) [3]. One of the highlights of this was guidelines and suggest that from the available documents it the recommendation against the use of LDL-C for assess- cannot be evaluated how this would work in relation to the ing coronary risk in patients with CKD. The reviewed European SCORE model. Therefore, they suggest that for published evidence showed weak and potentially mislead- the European population the SCORE charts or national ing association between LDL-C and coronary risk partic- charts calibrated on SCORE should be still recommended ularly in those with CKD, thereby mitigating against the [7]. Finally, EAS guideline committee comments no use of LDL-C for identifying CKD patients who should treatment goals of LDL-C in new ACC/AHA guidelines, receive lipid-lowering therapies. Nevertheless, the KDIGO although the option of having treatment goals has been Work Group recommended that follow-up measurement of accepted. They indicate that treatment goals are widely lipid levels should be reserved for instances in which the used in different clinical settings, such as for the treatment results would alter management, e.g., assessment of of arterial hypertension or type-2 diabetes, and targets are a adherence to statin treatment, change in renal replacement most important tool in daily practice, aiding patient-to- modality or concern about the presence of new secondary doctor communications and optimizing compliance, and causes of dyslipidemia, or assessment of 10-year CV risk in emphasize that risk reduction in general should be indi- patients younger than 50 years who are not currently vidualized for each patient, and this can be more specific if receiving a statin [3, 4]. targets are defined [7]. Finally, they take a notice that the Later that month, the American College of Cardiology EAS/European Society of Cardiology (ESC) (2011) (ACC) and the American Heart Association (AHA) pub- guidelines have a broader approach on dyslipidemia in lished very expected clinical practice guidelines for the general, while the ACC/AHA guidelines are focused on treatment of cholesterol in those at high risk of athero- statin treatment in cardiovascular prevention. Therefore, in sclerotic cardiovascular diseases (ASCVD) [5]. Corollary the EAS/ESC guidelines, special groups, such as individ- to the KDIGO guidelines [3, 4], the ACC/AHA recom- uals with familial hypercholesterolemia, combined hyper- mendations did not focus on specific target levels of LDL- lipidaemia and diabetes, and stroke patients, are discussed C and instead focused on four major groups of patients who more in detail. What is also very important the EAS/ESC are most likely to benefit from statin therapy, in terms of guidelines also include a more in-depth discussion and decreasing CV complications. These are: (1) patients with options on drug treatments other than statins, while in CVD, (2) patients with an LDL-C 190 mg/dL or higher, (3) ACC/AHA lipid guidelines no other lipid-lowering drugs patients with type 2 diabetes who are between 40 and (as well as the combined therapy) is discussed and rec- 75 years of age and (4) patients with an estimated 10-year ommended [7]. It is also worth mentioning the other lim- risk of CVD of 7.5 % or higher (based on new risk equa- itations of the American guidelines: (1) lack of inclusion of tion) who are between 40 and 75 years of age [5]. New risk all important randomized controlled trials (RCTs) on statin 123 Int Urol Nephrol therapy and therapeutic goals (the selectivity of RCTs subfractions). So, both the ‘‘quality’’ and the ‘‘quantity’’ inclusion); (2) lack of information on management with of plasma lipids and lipoproteins seem to essentially patient with side effects of statin therapy (including man- influence CV risk [23]. agement in patients with statin intolerance); (3) the arbi- trarily accepted age limit for the elderly patients (C75) Statin therapy update 2013 [8–11]. Despite well-established roles in primary and secondary New biomarkers of lipid disorders prevention of CVD, due to their positive effects on the plasma lipid profile, statin use is associated with some side Considering the complicated mechanisms and signals effects and residual risk [24]. Beyond their potent pharma- involved in atherosclerosis, research is now focused on cologic
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