How lipid-lowering agents work: The good, the bad, and the ugly

Abstract

Hyperlipidemia in the general population is strongly associated with atherosclerotic cardiovascular disease. Dyslipidemia is a common finding in patients with chronic kidney disease (CKD) at all stages. Trial results from the general population may not be applicable to all patients with CKD because they have a different lipid profile with increased atherogenic lipid fractions. Lipid-lowering therapies in these patients may have substantial benefit. Statin therapy is recommended in patients with CKD of any stage if they have elevated serum cholesterol levels. Treatment of dyslipidemia in patients with early stage CKD clearly reduces cardiovascular risk; however, available data do not support a strong nephroprotective role for statins in CKD population. In contrast to the predialysis patient population, statins do not seem to have substantial improvement in cardiovascular outcomes in dialysis patients. Although fibrates can be used to treat mixed dyslipidemia, they need to be used carefully in patients with CKD, and limited available data suggest that fibrates may have a place in reducing cardiovascular risk in patients with mild to moderate CKD.