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Letters |16 April 2002

Cardiovascular Outcomes and Renal Disease

Johannes F.E. Mann, MD; Hertzel C. Gerstein, MD; Salim Yusuf, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • The HOPE Office; McMaster University; Hamilton, Ontario L8L 2X2, Canada (Mann, Gerstein, Yusuf)
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McCullough and colleagues correctly point out that patients with even mild renal insufficiency exhibit an excess of car-diovascular risk factors. Controlling for such risk factors indicated that renal insufficiency is an additional, independent risk factor. This is also evident from Table 1 of our article. Therapeutic nihilism was obviously not a problem of the HOPE study because antiplatelet, blood pressure-lowering, and cholesterol-lowering agents were, if anything, more frequently administered in patients with renal insuf-ficiency than those without.
However, we emphasize that the results of the HOPE study contradict the common practice to withhold angiotensin-converting enzyme inhibitors, including ramipril, in patients with renal insuffi-ciency. We have no evidence that patients with renal insufficiency in the HOPE study received fewer thrombolytics; invasive procedures, including revascularization (a secondary outcome of the HOPE study); or β-blockers. It is entirely possible that risk factors we did not evaluate may explain some of the increased risk associated with even mild renal insufficiency. However, current experimental and clinical evidence indicates that some aspects of renal failure may promote atherosclerosis and may be treatable. Further research into these factors is necessary, and our article was published to stimulate such investigations.
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Mann JF, Gerstein HC, Yusuf S. Cardiovascular Outcomes and Renal Disease. Ann Intern Med. 2002;136:634. doi: 10.7326/0003-4819-136-8-200204160-00021

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Published: Ann Intern Med. 2002;136(8):634.

DOI: 10.7326/0003-4819-136-8-200204160-00021

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2002 American College of Physicians
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