Chronic kidney disease: The 'perfect storm' of cardiometabolic risk illuminates genetic diathesis in cardiovascular disease

摘要

A fact well known to the readers of the Journal: heart disease is the number 1 killer in our society, contributing to 600,000 deaths annually (1). Coronary heart disease (CHD) is responsible for approximately two-thirds of these deaths, and 935,000 Americans experience myocardial infarction (MI) each year (1). Hypertension, elevated low-density lipoprotein cholesterol levels, smoking, and diabetes are well appreciated as risk factors. However, a particularly ominous risk for CHD arises in the setting of chronic kidney disease (CKD) (2). As renal function declines below a glomerular nitration rate of 60 ml/min/1.73 m , the relative risk for cardiovascular mortality progressively increases by 3-fold, as compared with those without CKD (3), and almost 10-fold in the setting of CKD with diabetes (4). Indeed, the cardiovascular risk conveyed by CKD exceeds that conveyed by diabetes (5,6).