Elsayed EF, Tighiouart H, Griffith J et al. Arch Intern Med 2007;167(11):1130-6
The case for preventive intervention is particularly strong when the outcomes we are attempting to prevent feed back on the causative processes, creating a potential amplification loop.
Prevention is then not simply a matter of obstructing a process, but of breaking a cycle. Standard approaches to measuring the short-term impact of preventive interventions may fail to recognise this feedback, thereby underestimating the longer-term benefits.
The importance of renal impairment as a risk factor for CVD is well established, but the reverse association is less well-studied - the relevance of CVD as an independent risk factor for renal impairment and functional decline.
The authors of this study drew data from two longitudinal studies of CVD, the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study. Multivariate logistic regression analysis identified cardiovascular disease as an independent risk factor for decline in renal function, defined using changes in serum creatinine of eGFR. While this study alone cannot prove a causal association, it supports the case for cardiovascular risk reduction as a priority in those with, or at risk of, renal impairment.
- Dr Tim Holt is a GP and clinical lecturer, University of Warwick.