Editorial

Chronic Renal Failure and Diabetes Mellitus: Are They Comparable Risk Factors of Coronary Artery Disease?

Authors: Ashkan Mowla, MD, Seyed Alireza Dastgheib, MD, Abdolhameed Chodedri, MD, Ponya Dastouri, MD

Abstract

Cardiovascular morbidity and mortality are very important considerations in patients with chronic renal failure. For patients on dialysis, the probability of cardiovascular death is 50% after 10 years.1–4 For patients between the ages of 15 to 30 years, the incidence of cardiovascular death is 150 times greater than in the general population.5 The overall risk of cardiac death in the uremic population is increased by a factor of 5 to 20.4,6 Accelerated atherogenesis is often suggested, but has not been proven. Young dialysis patients have more advanced atherosclerotic changes than nonuremic controls, assessed by histologic examination of the iliac vasculature of uremic recipients and nonuremic donors at the time of renal transplantation.7 After percutaneous transluminal coronary angioplasty (PTCA), there is a 70% reocclusion rate in the uremic population, compared with 20 to 30% in any other risk group.6 Other data seem to contradict accelerated atherosclerosis. In the general population, major cardiovascular risk factors include hypertension, lipid abnormalities, left ventricular hypertrophy and glucose intolerance. These factors are frequently present in the uremic population and may have the same predictive value for atherosclerotic disease as in a nonuremic population.8,9 The incidence of coronary events does not increase with time on dialysis.4,6 Sequential coronary angiographies after two and five years in 5 patients with angina pectoris did not show any new lesions, which suggests that there was no accelerated atherosclerosis.10

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