By James Pope, MD

Cardiovascular disease is the leading cause of death in the United States, claiming 900,000 lives each year. For patients with chronic kidney disease (CKD), this statistic should be kept top of mind.

One of the unfortunate realities for patients with CKD is that they are at a much greater risk for cardiovascular disease than the general population. This is because CKD patients have higher incidences of many major risk factors, such as diabetes or hypertension. These risk factors may lead to cardiovascular conditions, such as coronary artery disease. In fact, half of all deaths among CKD patients are the result of cardiovascular disease.

Since 1975, deaths in the U.S. associated with cardiovascular disease dropped by approximately 25 percent, with help from a decline in smoking and improved control of hypertension and high cholesterol. Patients with renal troubles have not experienced such a large reduction, again because of higher risk levels.

With this in mind, CKD patients should focus on three key areas of action: watch for classic symptoms; aggressively manage risk factors; and get proper screenings and tests.

Classic symptoms

First, CKD patients should keep an eye out for symptoms that serve as early warning signs of cardiovascular disease, including shortness of breath, easy fatigue and declining functional capacity. Another common symptom is chest discomfort, such as heaviness or burning, induced by exercise.

Not all symptoms are easy to spot, and some heart conditions can develop with no early detection. So, it becomes critical that CKD patients also are aware of their risk factors and understand how to manage them.

Risk factors

Among the risk factors for cardiovascular disease are lifestyle habits, genetic history and medical conditions that predispose an individual to heart disease. For CKD patients, it is important to manage the following common risks as aggressively as possible to lessen the chance of developing cardiovascular disease. Please note, however, that this is not a complete list of potential risk factors.

Smoking cigarettes increases the risk of developing, and dying from, cardiovascular disease. However, if you quit smoking, the risk of heart attack and death is reduced by about 50 percent after one year, even if you previously smoked for several years. If you quit smoking for good, risk levels continue to decrease over time.

High blood pressure is a strong risk factor for coronary heart disease and has long been known as the “silent killer.” Blood pressure (BP) is reported as two numbers such as 120/80. The top (upper) number is known as the systolic BP while the lower (bottom) number is the diastolic BP. Despite common misconceptions, control of both is important in reducing the risk of coronary heart disease. Optimal blood pressure is usually cited at around 120/75 or lower. 

High cholesterol is another common challenge. Specifically, a certain type of cholesterol appears to be the culprit. The “bad” cholesterol is the low-density cholesterol known as LDL. Modifying your diet is one way to control cholesterol, but patients with CKD often have a number of nutritional concerns and should consult a doctor or dietician prior to starting a diet. If you are unable to reduce LDL by diet alone, your physician can prescribe a drug known as a statin, as long as there are no potential complications with this kind of medication, such as liver disease.

Diabetes is also a clear and very strong risk factor for the development of cardiovascular disease. Properly controlling diabetes will significantly reduce later complications of the disease and have an impact on the potential risks of cardiovascular disease that come as a result. 

Tests and Screening

Doctors use a wide variety of tests to screen for heart conditions. Stress tests are commonly used for patients with no known cardiovascular disease. An example of a stress test is when a doctor uses a treadmill exercise to check for heart problems. Additional methods of testing can involve injections of radioactive agents that can be tracked by cameras to find evidence of heart disease and x-rays of the heart using medical technology. In the end, no cardiovascular test is 100 percent accurate in detecting the disease. Your doctor should assess which test is best for you, based on your unique situation.

Regardless of current health status, CKD patients should always pay attention to symptoms, visit the doctor on a regular basis to address preventative health measures and get proper screenings for problems, as well as periodic tests to check BP, cholesterol and other risk factors. These simple steps, along with proper diet and regular exercise, can make an incredible difference for CKD patients in their quest to stay heart healthy.

Dr. James Pope is the chief medical officer for American Healthways, the nation’s leading and largest provider of disease management services. He has more than 25 years experience in health care, including 16 years operating a private cardiology practice in Tampa, Florida. He has repeatedly been named among the Best Doctors in America® and currently oversees all medical quality initiatives for American Healthways.

This article originally appeared in the September/October 2004 issue of Kidney Beginnings: The Magazine, Vol. 3, No. 3.

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