Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

Mar 29, 2021Hypertension (Dallas, Tex. : 1979)

Heart protection from diabetes and blood pressure drugs in chronic kidney disease

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Abstract

Patients with chronic kidney disease (CKD) face a high residual risk for cardiovascular disease progression despite standard treatment.

Chronic kidney disease and cardiovascular disease share common risk factors such as age, hypertension, and diabetes.
Reduced kidney function and the presence of albumin in urine are identified as independent risk factors for cardiovascular events and mortality.
ACE inhibitors and ARBs slow the progression of CKD but do not significantly reduce cardiovascular events or mortality.
SGLT-2 inhibitors and mineralocorticoid receptor antagonists show promise in providing cardioprotection alongside nephroprotection in patients with CKD.

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Chronic kidney disease (CKD) and cardiovascular disease are intimately linked. They share major risk factors, including age, hypertension, and diabetes, and common pathogenetic mechanisms. Furthermore, reduced renal function and kidney injury documented with albuminuria are independent risk factors for cardiovascular events and mortality. In major renal outcome trials and subsequent meta-analyses in patients with CKD, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) were shown to effectively retard CKD progression but not to significantly reduce cardiovascular events or mortality. Thus, a high residual risk for cardiovascular disease progression under standard-of-care treatment is still present for patients with CKD. In contrast to the above, several outcome trials with SGLT-2 (sodium-glucose cotransporter-2) inhibitors and MRAs (mineralocorticoid receptor antagonists) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article discusses existing evidence on the effects of SGLT-2 inhibitors and MRAs on cardiovascular outcomes in patients with CKD that open new roads in cardiovascular protection of this heavily burdened population.

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Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

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