Patients with chronic kidney disease (CKD) have a high prevalence of atherosclerotic cardiovascular disease, likely reflecting the presence of traditional risk factors. A greater distinguishing feature of atherosclerotic cardiovascular disease in CKD is the severity of the disease, which is reflective of an increase in inflammatory mediators and vascular calcification secondary to hyperparathyroidism of renal origin that are unique to patients with CKD. Additional components of atherosclerotic cardiovascular disease that are prominent in patients with CKD include microvascular disease and myocardial fibrosis. Therapeutic interventions that minimize cardiovascular events related to atherosclerotic cardiovascular disease in patients with CKD, as determined by well-designed clinical trials, are limited to statins. Data are lacking regarding other available therapeutic measures primarily due to exclusion of patients with CKD from major trials studying cardiovascular disease. Atherosclerotic plaque is the central feature of diseased coronary arteries leading to myocardial infarction (MI) and ultimately a damaged myocardium that leads to death or progression to heart failure; the term ASCVD replaces the prior terminology of coronary artery disease (CAD) given the interconnectedness between the diseases of the coronary and peripheral arteries.

Stable ischemic heart disease (SIHD) is a critical or subcritical coronary artery luminal narrowing that limits flow to the myocardium under stress. Acute coronary syndromes (ACS), including unstable angina and acute MI, the latter with biochemical evidence of myocardial injury (i.e., elevation in cardiac biomarkers), represent absence or limitation of coronary flow due to plaque rupture or new plaque formation and progression. Given that many of the available cardiovascular therapeutic techniques target these various plaque types, it is important to know whether the atherosclerotic plaque is similar in composition, behavior, or both in patients with CKD. Autopsy studies provide a direct look at anatomic pathology of coronary arteries and the associated atherosclerotic plaques. The few available studies have found remarkably consistent results: The amount of atheromatous plaques in CKD patients appears to be similar to those found in non-CKD patients.However, the atheromatous plaques were more calcified, with the presence of hydroxyapatite (i.e., calcium phosphate) and the presence of medial calcification in patients with CKD (i.e., predialysis and on hemodialysis) compared with those without CKD.

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Mishita
Jornal co-ordinator
Journal of Clinical & Experimental Nephrology