Cholesterol levels not useful to ID kidney disease patients at risk for heart attack: U of A medical research

Raquel Maurier - 16 May 2013

In the mainstream population, high cholesterol typically pinpoints those at risk of heart attack. But recently published medical research from the University of Alberta demonstrates that cholesterol level testing failed to accurately predict which patients with kidney disease or weak kidney function were at high risk for heart failure.

Faculty of Medicine & Dentistry researcher Marcello Tonelli and his colleagues just published their findings in the peer-reviewed journal, Journal of the American Society of Nephrology. Tonelli is a Canada Research Chair in the Department of Medicine and the School of Public Health at the U of A.

Via the Alberta Kidney Disease Network, Tonelli's research team reviewed the patient files of more than 800,000 Albertans with chronic kidney disease. They wanted to see if high cholesterol levels correctly identified patients at risk for heart disease in this group. The research review showed those with weak kidney function had a higher risk of heart attack compared to those with better kidney function. But those with weak kidney function had low cholesterol levels - so cholesterol levels aren't a good "marker" for pinpointing which kidney disease patients are at risk of heart attack, says Tonelli.

"Heart disease is the number one killer of people with kidney disease. They are high risk - right across the board. Our research showed that looking at their cholesterol levels gives physicians a false picture of the patients' heart health, and isn't very useful in identifying who is really at risk," the researcher says.

In the general population, patients are prescribed statin medication to lower their cholesterol levels if they are too high. More recently, it has become clear that statins reduce the risk of heart attack and stroke for everyone regardless of their cholesterol levels.

Because this medication can benefit anyone, including those with normal cholesterol levels, the new standard in health care is to treat diabetics with statin because they are considered a high-risk group - a group that is more prone to heart disease.

Tonelli and his research team initiated this study because they thought that the risk in patients with kidney disease might justify a similar approach to that used for diabetics - prescribing statin as part of their regular course of treatment. Their research uncovered that after four years, many patients with chronic kidney disease were hospitalized for heart disease - and higher levels of cholesterol wasn't useful for determining who was at risk.

"Our recommendation to treat all kidney disease patients with statin is good news for doctors and patients. The recommendation makes caring for these patients simpler - it's one less thing to monitor, one less thing to worry about," Tonelli says.

The recommendation from their research was recently cited in the new Canadian guidelines for the treatment and management of cholesterol.

The research was funded by Alberta Innovates - Health Solutions.