Whats The Role Of Statins In Lowering Cholesterol
In the general population, cholesterol-lowering therapy with statins is thought to provide benefit in two ways. Firstly, conferring nearly immediate benefit by stabilising cholesterol plaques and making them less likely to rupture . Secondly, by lowering cholesterol with time and therefore reducing the deposition of cholesterol plaques in the coronary arteries.In the 1990s statins were shown to be effective at primary prevention, such as preventing heart attacks in people at risk of a heart attack but who had not yet had a heart attack.3 They also proved to be effective in secondary prevention, 4 preventing further heart attacks in people who had already experienced one heart attack.
Normal Physiology Of Lipoproteins
Before discussing lipoprotein abnormalities in CKD, a brief explanation of normal lipoprotein physiology is necessary. Lipoproteins are macromolecular particles composed of characteristic lipids and proteins that serve to transport the otherwise insoluble triglycerides and cholesterol molecules. Lipoproteins consist of a coat composed of a monolayer of amphipathic lipids and apolipoproteins that surround a core composed of hydrophobic lipids. Since they both have hydrophobic and hydrophilic parts, they can interact with both the aqueous environment of the plasma and the hydrophobic core lipids. Circulating lipoproteins range in size from 5 to > 1,000 nm, and can be separated according to density. HDL are small, containing the least lipid and the most protein, whereas chylomicrons are large and lipid-rich. Lipoproteins are also distinguished by their apolipoprotein contents. Lipoproteins have mainly 2 major functions: One is the delivery of cholesterol and triglyceride molecules from the liver and intestine to muscle and fat tissue via mainly very low-density lipoprotein particles that contain apoB48 and apoB100 or LDL particles. The other function is to assist the transport of excess cholesterol from extrahepatic tissues to the liver for elimination via the bile, which is mediated primarily by HDL particles .
How Does High Blood Pressure Affect The Kidneys
High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. The narrowing reduces blood flow.
If your kidneys blood vessels are damaged, they may no longer work properly. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.
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Kidney Disease Can Affect Anyone
Kidney disease doesnt care if you work out, if youre young, or if you eat healthy.
Black Americans are 4-5x more likely to develop kidney failure than White Americans. Although the Black community faces a higher risk, there are preventative measures that can be taken.
Learn more about what steps you can take and how you can talk to your doctor about your kidney health. Plus, hear from real patients and get the facts about kidney disease.
D.B. Marshall seemed like the picture of health in his late 20s, but was stopped in his tracks one day after randomly fainting. He never thought kidney disease would be the underlying reason. Learn more about his inspiring story.
What Can You Do To Help Slow The Progression Of Kidney Disease
Unfortunately, there is no cure for kidney disease, although there are medications that can help slow its progression. Once established, the only thing you can do is to slow the progression, therefore, reducing all risk factors to try to prevent getting kidney disease in the first place is a healthy approach.
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Can Dehydration Affect An Electrolyte Test
Yes. Electrolytes are minerals found in body tissues and fluids in the form of dissolved salts, and are responsible for maintaining a healthy water balance. A typical electrolyte panel measures sodium, potassium, chloride, and bicarbonate. Any condition that affects the amount of fluid in the bodyincluding dehydrationcan cause an electrolyte imbalance.
What Treatments Are Available For High Cholesterol
Treatment may include:
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Addressing risk factors. Some risk factors that can be changed include lack of exercise and poor eating habits.
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Cholesterol-lowering medicines. Medicines are used to lower fats in the blood, particularly LDL cholesterol. Statins are a group of medicines that can do this. The two most effective types are atorvastatin and rosuvastatin. Other medicines that lower cholesterol levels are ezetimibe and PCSK9 inhibitors.
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How To Prevent Complications
Garg emphasizes that to address or prevent any complications from high cholesterol, the first thing patients need to do is identify what about their lifestyle can be improved, with the help of their healthcare team. The American Heart Association recommends reducing saturated and trans fats in your diet focusing on fruit, vegetables, whole grains, and lean protein exercising at a moderate intensity for at least 150 minutes a week and losing excess weight.
Once we get beyond , then we start to talk about what medications we can use to further reduce risk, says Garg.
There are a number of cholesterol-lowering medications, according to the AHA. The most commonly prescribed are statins, which work in the liver to prevent cholesterol from forming and can help reduce your risk of heart attack and stroke. Others include PCSK9 inhibitors, selective cholesterol absorption inhibitors, bile acid sequestrants, niacin, and fibrates. Talk to your doctor about which medication or combination of medications is right for you.
What Are The Symptoms Of High Blood Pressure And Kidney Disease
Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches.
Early CKD also may not have symptoms. As kidney disease gets worse, some people may have swelling, called edema. Edema happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, ankles, orless oftenin the hands or face.
Symptoms of advanced kidney disease can include
- loss of appetite, nausea, or vomiting
- drowsiness, feeling tired, or sleep problems
- headaches or trouble concentrating
- chest pain or shortness of breath
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Get In Gear With Exercise
Moving more can lower your LDL and raise your HDL, according to the Cleveland Clinic. Exactly how exercise does this is still being researched, but there are a few possibilities. Working out might increase the size of your LDL particles so they pose less of a heart disease risk, studies have shown. It might also speed the delivery of cholesterol to the liver, studies in mice have suggested. Exercise might also reduce the amount of cholesterol absorbed into the bloodstream.
Burning more calories can also, of course, help you drop pounds, which has benefits for all elements of your cholesterol profile. Aim to get in:
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At least 150 minutes a week of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity every week
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Muscle-building, weight-training workouts at least two days a week
If this seems like a lot, dont get overwhelmedyou can start where you are and build up gradually from there. In fact, you can exercise in short nuggets throughout the day to chip away at your weekly goals. An activity as simple as a brisk daily walk or yard work is a good place to begin getting some more movement into your life. What matters is that you try to make exercise part of your everyday life.
Are All Approaches To Lipid Lowering Equal
The available data strongly suggest that the cardiovascular benefits of lipid-lowering therapy with statins and/or ezetimibe are directly related to the degree of LDL-C lowering achieved. This observation provides support for the use of the highest safe dose of an appropriate agent in individuals at risk.
There are questions about whether all agents are the same and what the preferred statin dose should be used in people with CKD. Subgroup analyses of trials comparing high vs. low intensity statins in the general population suggest that people with CKD had at least equivalent benefit to those with normal kidney function when high-dose agents were used,, without reported differences in the rates of adverse effects.
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Cholesterol And Chronic Kidney Disease
Cardiovascular disease is common in people with chronic kidney disease . Many already have a diagnosis of cardiovascular disease prior to being diagnosed with chronic kidney disease. Cardiovascular disease is the leading cause of death in people with kidney disease, regardless of the stage. Its important to understand the risk factors for cardiovascular disease, especially the ones specific to chronic kidney disease. Find out what types of fats you should limit and cholesterols that are important to help you stay healthy and active.
Risk factors for cardiovascular disease
High cholesterol levels have been linked to heart disease and stroke. For people without chronic kidney disease, risk factors for heart disease include:
- High total cholesterol
- Family history
- Left ventricular hypertrophy , or enlargement of the left side of the heart
Some of these risk factors, including smoking and blood pressure, can be controlled with lifestyle changes or medicines, while the other factors, such as age or family history, are out of your control.
Risk factors for cardiovascular disease in people with kidney disease
In addition, there are cardiovascular risk factors unique to chronic kidney disease patients. These include:
- Protein in the urine
- Malnutrition
- Inflammation
Cholesterol
What are the cholesterol and triglyceride goals for kidney patients?
For good total cholesterol, the goal is less than 200 mg/dL . Below, Table 1 shows what cholesterol is too low and what is too high.
Table 1.
Other Causes Of High Cholesterol
People are often surprised to find out they have high cholesterol or triglycerides in their blood, but there are many possible explanations. High levels of blood fats can have many different causes which can all add up, including your lifestyle, genes, age, gender and ethnic background.
Here you can take a look at some of the lesser-known causes. Doctors sometimes call these ‘secondary causes’ of high cholesterol.
Learn about changing your lifestyle to help lower your cholesterol
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What Other Steps Can Be Taken By Your Healthcare Team To Slow Kidney Damage
Already mentioned above is the use of medications such as RAAS inhibitors. These medications are thought to work by reducing pressure within the nephrons in the kidneys, thereby reducing the damage that is happening during the process of kidney disease and slowing the progress of kidney damage. Moreover, newer diabetes medications, sodium glucose co-transporter 2 inhibitors, which lower glucose, have also been shown to slow the progression of kidney disease in people with diabetes and protein in their urine. Speak to your diabetes team to learn if these medications are appropriate for you.
This article was sponsored by Janssen Inc.
Potential Effects And Risks Of High Cholesterol
The potential risks of high cholesterol are far-reaching. High cholesterol can affect your blood vessels by making them narrow or causing blockages. Because your blood vessels are present in all of your organ systems, high cholesterol can affect your body in a myriad of ways. Many of the issues high cholesterol causes can be potentially serious.
The potential effects and risks of high cholesterol include:
- Narrowing of the arteries
- Reduced blood flow
- Transient ischemic attack sometimes called a mini-stroke
- Peripheral artery disease
- Kidney stones
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Proprotein Convertase Subtilisin/kexin Type 9 Effect On Lipid Profile
Proprotein convertase subtilisin/kexin type 9 is an enzyme also accepted as a new biomarker for lipid metabolism, a novel pharmacological target for hypercholesterolemia, since the inhibition of PCSK9 may be one of the management options to decrease CVD risk . PCSK9 is primarily synthesized by the liver, intestine, and kidney as a precursor of the 75 kDa protein it then undergoes autocatalytic cleavage in the endoplasmic reticulum and secreted as a heterodimer protein . PCSK9 causes a reduction in the number of LDL cholesterol receptor by enhancing the degradation of hepatic LDL receptor and this reduces LDL cholesterol uptake leading to a subsequent increase in circulating LDL cholesterol levels . In addition, recent studies showed that very low-density lipoprotein receptor and apolipoprotein E2 receptor are also partly regulated by PCSK9 .
There are contradictory results about the serum PCSK9 level in CKD patients. PCSK9 levels were found to be almost 2 times higher in CKD patients compared with subjects with normal kidney function . In contrast, Rogacev et al. found no correlation between eGFR and PCSK9 levels in CKD patients. Furthermore, PCSK9 concentrations did not predict new CVD events in this study . Lastly, PCSK9 levels are positively correlated with proteinuria in patients with nephrotic syndrome .
How Can I Protect My Kidneys From High Blood Pressure
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Evidence Of Lipid Involvement In Renal Damage: Effect Of Statins
In recent years, the inhibition of 3-hydroxy-3-methylglutaryl CoA reductase by statins has demonstrated beneficial effects in different models of progressive renal failure . It is interesting that some of the beneficial effects of statins can be seen independent of the cholesterol reduction. In an elegant study by Zoja et al. , it was shown that a combined angiotensin-converting enzyme inhibitor and statin therapy had a remarkable antiproteinuric effect with a significant improvement in renal function. Drug combination limited glomerulosclerosis, tubular damage, and interstitial inflammation, compared with placebo or drugs alone.
In vitro studies have established clearly that statins influence important intracellular pathways that are involved in the inflammatory and fibrogenic responses, which are common components of many forms of progressive renal injury . Statins also inhibit proliferation of cultured mesangial cells and renal epithelial tubular cells through their capability to suppress the formation of intermediate metabolites of the mevalonate pathway, particularly the nonsterol isoprenoids, which seem to be essential in cell replication .
High Cholesterol = High Kidney Disease Risk
Abnormal cholesterol levels are a hazard to the kidneys, according to the Physicians’ Health Study. This study has been following about 4500 men for 14 years. People with high total cholesterol or reduced HDL cholesterol were more likely to have reduced glomerular filtration rate . This is the best way to assess kidney function. A GFR of 60 or lower usually means chronic kidney disease. In fact, people with cholesterol problems were twice as likely to have chronic kidney disease over time.
This raises the possibility that one way to slow the onset of chronic kidney disease would be controlling a person’s cholesterol levels. Prevention is important because kidney disease is a serious and growing problem both in terms of lives lost, losses in quality of life, and costs of treatment. If kidney disease isn’t slowed down or stopped, many more people will need renal replacement therapy in the form of kidney transplantation or dialysis.
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What Clinical Studies For High Blood Pressure And Kidney Disease Are Looking For Participants
You can view a filtered list of clinical studies on high blood pressure and kidney disease that are federally funded, open, and recruiting at www.ClinicalTrials.gov. You can expand or narrow the list to include clinical studies from industry, universities, and individuals however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care professional before you participate in a clinical study.
Impaired Reverse Cholesterol Transport
Reverse cholesterol transport is a process responsible for clearing excess cholesterol from the arterial wall and is therefore considered a crucial defense mechanism against atherosclerosis. Cellular cholesterol homeostasis is exquisitely maintained so that cholesterol inflow is balanced by cholesterol outflow. Influx of oxidized lipids and lipoproteins occurs mainly though scavenger receptors. Cholesterol efflux occurs through multiple pathways. In reverse cholesterol transport, excess cholesterol is moved from peripheral cells, such as lipid-overloaded macrophages found in atherosclerotic plaque, to the plasma and finally to the liver for excretion into feces either as neutral sterols or after metabolic conversion into bile acids .
Reverse cholesterol transport in chronic kidney disease
Abbreviations: ABCA1 and G1, ATP-binding cassette sub-family A1 and G1 members ACAT, acyl coenzyme A:cholesterol acyltransferase apoA-I apolipoprotein A-I CETP, cholesteryl ester transfer protein HDL, high density lipoprotein LCAT, lecithin cholesterol acyltransferase LOX1, lectin-like oxidized LDL receptor 1 NO, nitric oxide PON1, serum paraoxonase/arylesterase 1 ROS, reactive oxygen species SRA1/B1, scavenger receptor class A member 1/class B member 1 VLDL, very low density lipoprotein.
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How Does High Blood Pressure Cause Kidney Disease
Your kidneys are made of tiny blood vessels that help clean your blood. When you have high blood pressure, the blood flows through these blood vessels with a lot of force. This can harm these blood vessels and cause kidney disease. However, high blood pressure can also be a symptom of kidney disease. Kidneys help your body control your blood pressure. When high blood pressure damages your kidneys, they cannot control your blood pressure very well.
You will not be able to feel if high blood pressure has hurt your kidneys. The only way to know is to be tested. Learn more about the tests for kidney disease.
Smoking Or Exposure To Tobacco Smoke
Add high cholesterol to the list of why smoking is so bad for you. Smoking can lower good HDL cholesterol, and smokers who already have high cholesterol have a greater risk of developing coronary artery disease, according to The American Heart Association. Smoking can also raise blood pressure and increase other heart disease risk factors.
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