Are cardioprotective drugs underused after a myocardial infarction in patients who suffer from chronic kidney disease?

作者：Cardinal Heloise^*; Madore Francois

来源：Nephrologie & Therapeutique, 2010, 6(3): 162-170.

DOI：10.1016/j.nephro.2009.10.003

• Chronic kidney disease
• Myocardial infarction
• Secondary prevention
• Therapy
• Underuse

Chronic kidney disease (CKD) is strongly associated with cardiovascular disease. After a myocardial infarction (MI), the risk of recurrent events is much higher in subjects suffering from CKD, even when traditional risk factors are taken into account. Some data suggest that thrombolysis and coronary revascularization are underused during acute MI episodes in subjects who suffer from CKD. We performed a systematic review of the medical literature to ascertain whether there is also a CKD-associated decrease in the use of cardioprotective medications (aspirin, beta-blockers, ACE inhibitors and lipid lowering drugs) after a MI. We did observe a CKD-associated underuse of these medications in this particular clinical context. The presence of co-morbidities and co-treatments, as well as the relative lack of evidence-based data on the efficacy of cardiopreventive drugs in patients with CKD probably explain much of the reported therapeutic differences. However, recent studies show that the differences in cardioprotective drug use across levels of kidney function tend to diminish over the years. This probably reflects a greater awareness of the high cardiovascular risk associated with CKD amongst clinicians caring for these patients.

• 出版日期2010-6