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Canadian Journal of Cardiology

Determinants and Prevention of Coronary Disease in Patients With Chronic Kidney Disease

      Abstract

      Chronic kidney disease (CKD) is associated with premature cardiovascular morbidity and mortality. Traditional Framingham risk factors contribute partially to the malignant form of cardiovascular disease in CKD. Uremic-specific risk factors including chronic inflammation, retention of uremic toxins, and abnormal bone mineral metabolism have independently been linked to the pathogenesis of premature vascular aging, atherosclerosis, and cardiovascular disease. In this review we explore the mechanisms by which premature aging occurs in CKD through its pathologic effects on cardiovascular health, and the determinants of cardiac disease in patients with CKD. We outline strategies for prevention and therapeutic interventions in this vulnerable population.

      Résumé

      L’insuffisance rénale chronique (IRC) est associée à une morbidité et à une mortalité cardiovasculaires prématurées. Les facteurs de risque classiques définis dans le cadre de l’étude de Framingham contribuent en partie à la forme maligne des maladies cardiovasculaires chez les patients atteints d’IRC. Des facteurs de risque urémiques, notamment l’inflammation chronique, la rétention de toxines urémiques et un métabolisme minéral osseux anormal, ont été liés indépendamment à la pathogenèse du vieillissement vasculaire prématuré, de l’athérosclérose et des maladies cardiovasculaires. Dans le présent article, nous examinons les mécanismes par lesquels le vieillissement prématuré se produit en présence d’IRC à la suite de ses effets pathologiques sur la santé cardiovasculaire. Nous abordons aussi les déterminants des cardiopathies chez les patients atteints d’IRC. Nous exposons les grandes lignes de stratégies de prévention et d’interventions thérapeutiques applicables au sein de cette population vulnérable.
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