Abstract Purpose of Review The natural fate of chronic kidney disease (CKD) is the progression to dialysis; however, most patients face fatal and nonfatal cardiovascular events throughout their lifetime. We here address the role of low-density lipoprotein cholesterol (LDL-C) in the excess cardiovascular risk and the impact of traditional and innovative LDL-lowering therapies across the whole spectrum of CKD. Recent Findings Current guidelines on the prevention of atherosclerotic cardiovascular disease (ASCVD) from European and US cardiology societies recommend the assessment of total cardiovascular disease risk to modulate the intensity of preventive strategies in relation to the cardiovascular risk of patients: the higher the cardiovascular risk, the more intense should be the intervention. New drugs have demonstrated efficacy in achieving the lower LDL-C goals not attained by traditional therapy. The detection of vulnerable coronary plaque, rather than merely be the presence of luminal narrowing, provides an attractive imaging target to guide intensified preventive strategies in high-risk population including patients with CKD. Summary In the context of CKD, the patient journey represents a dynamic, longitudinal care pathway in which cardiovascular risk progressively increases in parallel with declining renal function. Despite clear recommendations from nephrology and non-nephrology guidelines, treatment initiation, maintenance and intensification as well as LDL-C target are frequently overlooked in CKD population. Since novel LDL-lowering therapies provide additional therapeutic options for the patients with CKD, it is today mandatory to raise awareness on cardiovascular risk and to integrate lipid management into the broader, longitudinal care of patients with CKD across all stages of disease.
Minutolo et al. (Sat,) studied this question.