Peter A. McCullough, MD, MPH; Keisha R. Sandberg, BS; Steven Borzak, MD
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McCullough P., Sandberg K., Borzak S.; Cardiovascular Outcomes and Renal Disease. Ann Intern Med. 2002;136:633-634. doi: 10.7326/0003-4819-136-8-200204160-00020
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Published: Ann Intern Med. 2002;136(8):633-634.
TO THE EDITOR:
Mann and coworkers (1) reported on the independent association between baseline renal insufficiency (serum creatinine level, 124 to 200 µmol/L [1.4 to 2.3 mg/dL]) and cardiovascular outcomes in the Heart Outcomes and Prevention Evaluation (HOPE) study. Although the Discussion section of the paper focuses on the pathophysiologic reasoning for why renal insufficiency may accelerate atherosclerosis, the authors have missed the larger picture of “cardiorenal risk” (1).
We believe that there are four explanations for poor outcomes in patients with renal insufficiency: 1) excess and incompletely controlled confounding of conventional risk factors, 2) therapeutic nihilism, 3) complications from conventional therapies and procedures, and 4) special biological features of the renal failure state that promote atherosclerosis, heart failure, arrhythmias, and valvular disease. Mann and coworkers' study could not touch on these factors because most of them occur during hospitalization for cardiovascular events (2). We and others have shown the mathematical risk for acute renal failure that requires dialysis and for subsequent mortality after acute coronary intervention and bypass surgery in patients with renal insufficiency (3–5). In addition, we recently demonstrated lower rates of therapy with thrombolytics, primary angioplasty, and β-blockers in patients with renal insufficiency (5). These and other factors produce the results demonstrated by Mann and colleagues' study and those seen in clinical care. Although we agree with the authors that accelerated atherosclerosis is a central feature of cardiorenal risk, we encourage the clinical and research community to consider the issue in broader terms based on published observations.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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