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Am J Kidney Dis. 2014 May;63(5):753-60. doi: 10.1053/j.ajkd.2013.11.014. Epub 2013 Dec 25.

Potential effects of reclassifying CKD as a coronary heart disease risk equivalent in the US population.

Author information

1
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD.
2
Merck, Sharp & Dohme Corp, Whitehouse Station, NJ.
3
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
4
Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.
5
National Kidney Foundation, New York, NY.
6
William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA.
7
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Medicine, Johns Hopkins Hospital, Baltimore, MD.
8
Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health and Medical Institutions, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: lselvin@jhsph.edu.

Abstract

BACKGROUND:

Persons with chronic kidney disease (CKD) are at high risk for cardiovascular disease events, but are not classified as such in current US cholesterol treatment guidelines. We examined potential effects of modified guidelines in which CKD was considered a "coronary heart disease (CHD) risk equivalent" for risk stratification.

STUDY DESIGN:

Nationally representative cross-sectional study.

SETTING & PARTICIPANTS:

4,823 adults 20 years or older from the 2007-2010 National Health and Nutrition Examination Survey.

PREDICTORS:

Cardiovascular risk stratification based on current US cholesterol treatment guidelines and 2 simulated scenarios in which CKD stages 3-5 or CKD stages 1-5 were considered a CHD risk equivalent.

OUTCOMES & MEASUREMENTS:

Proportion of persons with low-density lipoprotein (LDL) cholesterol at levels above treatment targets and above the threshold for lipid-lowering therapy initiation, based on current guidelines and the 2 simulated scenarios.

RESULTS:

Under current guidelines, 55.1 million adults in 2010 did not achieve the target LDL cholesterol goal. Of these, 25.2 million had sufficiently elevated levels to meet recommendations for initiating lipid-lowering therapy; 12.1 million were receiving this therapy but remained above goal. When CKD stages 3-5 were considered a CHD risk equivalent, 59.2 million persons were above target LDL cholesterol goals, with 28.5 million and 13.3 million meriting therapy initiation and intensification, respectively. When CKD stages 1-5 were considered a CHD risk equivalent, 65.2 million adults were above goal, with 33.9 million and 14.4 million meriting therapy initiation and intensification, respectively.

LIMITATIONS:

CKD and LDL cholesterol defined using a single laboratory value.

CONCLUSIONS:

Many adults in the United States currently do not meet recommended goals for LDL cholesterol levels. Modifying the current cholesterol guidelines to include CKD as a CHD risk equivalent would lead to a substantial increase in both the number of persons with levels above LDL cholesterol treatment targets and those recommended to initiate lipid-lowering therapy.

KEYWORDS:

Chronic kidney disease; National Health and Nutrition Examination Survey (NHANES); cholesterol treatment guidelines; coronary heart disease (CHD) risk equivalents; guideline implementation; low-density lipoprotein (LDL) cholesterol; public health

PMID:
24369751
PMCID:
PMC3988260
DOI:
10.1053/j.ajkd.2013.11.014
[Indexed for MEDLINE]
Free PMC Article
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