An article published Online First in The Lancet reveals that the risk of coronary heart disease in patients with chronic kidney disease is as high as that of patients who had a previous heart attack.

Scientists have long known that chronic kidney disease patients have a higher risk of heart attacks. However, researchers from the University of Alberta decided to conduct a new and the first large-scale, long-term study to assess whether kidney disease carries the same risk in terms of future coronary events than that of people who previously suffered a heart attack.

Dr Marcello Tonelli, who led the research, commented:

“Our research suggests that there is a strong case for considering chronic kidney disease to be a coronary heart disease risk equivalent, meaning that people with chronic kidney disease are at a comparable risk of coronary events to those who have previously had a heart attack. Chronic kidney disease patients have substantially higher rates of death from heart disease after a heart attack than the general population, which emphasizes the potential value of preventing coronary events through drug treatment and lifestyle interventions. In fact, the rate of death from heart disease among people with chronic kidney disease was similar to or higher than the rate of death among people with diabetes – in whom the value of preventive treatments is well known.”

After comparing data of nearly 1.3 million Canadian patients in terms of heart attack incidence rates and patient deaths who suffered at least one previous heart attack or who had either chronic kidney disease, diabetes, or a combination of these risk factors, the team discovered that those with chronic kidney disease, diabetes, or both had a similar risk of heart attack, compared with those who previously had a heart attack.

The finding suggests that kidney disease could potentially be seen as a useful prognostic marker for coronary heart disease.

The results of the study are significant due to the fact that patients identified as having the same risk as those with coronary heart disease can receive targeted therapy. For instance, drugs like statins, which lower the risk of coronary events by decreasing “bad” fats (lipids) in the blood. Nearly 9% of people in the UK are estimated to suffer from chronic kidney disease. In many cases people with chronic kidney disease are also diabetic, which is already believed to be of the equivalent risk to the risk of coronary heart disease.

George Bakris of The University of Chicago warns in a linked comment to be cautious when interpreting the results. He indicates that despite the advantage of the study being of large scale, the findings do not necessarily offer a clear-cut support of the risk of chronic kidney disease being equivalent to that of coronary heart disease, if the data with regard to the participants’ medications and other factors, including the participants’ blood pressure may be insufficient.

However, Bakris states that the study could still be likely to have significant effects in terms of coronary disease prevention strategies, even if further investigations fail to support that chronic kidney disease has the equivalent risk as coronary heart disease.

Professor Bakris concludes:

“Tonelli and colleagues offer new insight by comparing individuals with chronic kidney disease with those who have a history of heart attack, on a very large scale. Their findings emphasize the importance of primary prevention, particularly because patients with chronic kidney disease comprise a large proportion of patients who have heart attack.”

Written By Petra Rattue