Meredith C Foster1, Andreea M Rawlings1, Elizabeth Marrett2, David Neff2, Morgan E Grams3, Bertram L Kasiske4, Kerry Willis5, Lesley A Inker6, Josef Coresh7, Elizabeth Selvin8. 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.
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.
Authors: Christoph Wanner; Vera Krane; Winfried März; Manfred Olschewski; Johannes F E Mann; Günther Ruf; Eberhard Ritz Journal: N Engl J Med Date: 2005-07-21 Impact factor: 91.245
Authors: Scott M Grundy; James I Cleeman; C Noel Bairey Merz; H Bryan Brewer; Luther T Clark; Donald B Hunninghake; Richard C Pasternak; Sidney C Smith; Neil J Stone Journal: Circulation Date: 2004-07-13 Impact factor: 29.690
Authors: Meredith C Foster; Andreea M Rawlings; Elizabeth Marrett; David Neff; Kerry Willis; Lesley A Inker; Josef Coresh; Elizabeth Selvin Journal: Am Heart J Date: 2013-05-01 Impact factor: 4.749
Authors: Mark J Sarnak; Andrew S Levey; Anton C Schoolwerth; Josef Coresh; Bruce Culleton; L Lee Hamm; Peter A McCullough; Bertram L Kasiske; Ellie Kelepouris; Michael J Klag; Patrick Parfrey; Marc Pfeffer; Leopoldo Raij; David J Spinosa; Peter W Wilson Journal: Circulation Date: 2003-10-28 Impact factor: 29.690
Authors: Paul E Drawz; Sarah Baraniuk; Barry R Davis; Clinton D Brown; Pedro J Colon; Aloysius B Cujyet; Richard A Dart; James F Graumlich; Mario A Henriquez; Jamaluddin Moloo; Mohammed G Sakalayen; Debra L Simmons; Carol Stanford; Mary Ellen Sweeney; Nathan D Wong; Mahboob Rahman Journal: Am Heart J Date: 2012-10-29 Impact factor: 4.749
Authors: Lisandro D Colantonio; Usman Baber; Maciej Banach; Rikki M Tanner; David G Warnock; Orlando M Gutiérrez; Monika M Safford; Christoph Wanner; George Howard; Paul Muntner Journal: J Am Soc Nephrol Date: 2014-11-13 Impact factor: 10.121
Authors: Byung Sub Moon; Jongho Kim; Ji Hyun Kim; Young Youl Hyun; Se Eun Park; Hyung Geun Oh; Cheol Young Park; Won Young Lee; Ki Won Oh; Kyu Beck Lee; Hyang Kim; Sung Woo Park; Eun Jung Rhee Journal: Endocrinol Metab (Seoul) Date: 2016-08-26
Authors: Seamus P Whelton; John W McEvoy; Mariana Lazo; Josef Coresh; Christie M Ballantyne; Elizabeth Selvin Journal: Diabetes Care Date: 2016-11-15 Impact factor: 19.112
Authors: Tariq E Farrah; Atul Anand; Peter J Gallacher; Robert Kimmitt; Edwin Carter; James W Dear; Nicholas L Mills; David J Webb; Neeraj Dhaun Journal: Hypertension Date: 2019-06-10 Impact factor: 10.190