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Nephrol Dial Transplant (2004) 19: 23-26
© ERA–EDTA 2003; all rights reserved

Editorial Comment

Cardiovascular risk in patients with renal disease: treating the risk or treating the risk factor?

Ton J. Rabelink

University Medical Center Utrecht, Internal Medicine, Utrecht, The Netherlands

Correspondence and offprint requests to: Professor Ton J. Rabelink, University Medical Center Utrecht, Internal Medicine, Room G 02.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Email: t.rabelink@azu.nl

Keywords: antiplatelet therapy; blood pressure control; cardiovascular risk; folic acid; lipid-lowering treatment

The first 150 words of the full text of this article appear below.



   Introduction
 
Cardiovascular mortality in patients with end-stage renal failure is probably among the highest in medicine. In the younger age group (25–34 years) this may exceed the cardiovascular mortality risk of a normal population by several hundred times, while in the age segment 45–55 years it is still more than 50 times the normal annual mortality [1,2]. From this observation, two important lessons are to be learned.

(i) Normally the atherosclerosis process takes decades to develop to a clinically relevant extent. The fact that these young subjects already have such a high cardiovascular mortality indicates that in the phase before arriving at end-stage renal failure, most of the cardiovascular damage has already occurred. Indeed, several studies and surveys have demonstrated that even mild renal impairment already carries an increased risk for cardiovascular death [3,4]. Therefore, any strategy to reduce this very high cardiovascular . . . [Full Text of this Article]



   Importance of absolute risk
 


   Lipid-lowering treatment for all patients with end-stage renal disease?
 


   Importance of optimal blood pressure control
 


   How about antiplatelet therapy?
 


   Usefulness of systematic folate supplementation
 


   Other disease-specific risk factors
 


   Drug prescription vs lifestyle changes
 

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