Incidence Of Atherosclerotic Renal Artery Stenosis Research Articles

Lipoprotein (a) as a residual risk factor for atherosclerotic renal artery stenosis in hypertensive patients: a hospital-based cross-sectional study

BackgroundLow-density lipoprotein cholesterol (LDL-c) has been proven to be a risk factor for atherosclerotic cardiovascular disease (CVD), while lipoprotein (a) (Lp(a)) is a residual risk factor for CVD, even though LDL-c is well controlled by statin use. Importantly, the role of Lp(a) in atherosclerotic renal artery stenosis (ARAS) is still unknown.MethodsFor this hospital-based cross-sectional study, patients who simultaneously underwent coronary and renal angiography were examined. ARAS was defined as a 50% reduction in the cross-sectional (two-dimensional plane) area of the renal artery. Data were collected and compared between ARAS and non-ARAS groups, including clinical history and metabolite profiles. Univariate analysis, three tertile LDL-c-based stratified analysis, and multivariate-adjusted logistic analysis were conducted, revealing a correlation between Lp(a) and ARAS.ResultsA total of 170 hypertensive patients were included in this study, 85 with ARAS and 85 with non-RAS. Baseline information indicated comparability between the two groups. In the univariate and multivariate analysis, common risk factors for atherosclerosis were not significantly different. Stratified analysis of LDL-c revealed a significant increase in the incidence of ARAS in patients who had high Lp(a) concentrations at low LDL-c levels (odds ratio (OR): 4.77, 95% confidence interval (CI): 1.04–21.79, P = 0.044). Further logistic analysis with adjusted covariates also confirmed the result, indicating that high Lp(a) levels were independently associated with ARAS (adjusted OR (aOR): 6.14, 95%CI: 1.03–36.47, P = 0.046). This relationship increased with increasing Lp(a) concentration based on a curve fitting graph. These results were not present in the low and intermediate LDL-c-level groups.ConclusionIn hypertensive patients who present low LDL-c, high Lp(a) was significantly associated with atherosclerotic renal artery stenosis and thus is a residual risk factor.

Study of angiographic association of atherosclerotic renal artery stenosis with coronary artery disease in Bangladesh

This retrospective observational study aimed to see the angiographic association of atherosclerotic renal-artery stenosis (ARAS) with coronary artery disease in Bangladesh. It was conducted in department of cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2007 to January 2008. A total of 250 patients with coronary artery involvement, on non-emergent coronary angiogram who underwent either selective or nonselective renal angiography were enrolled in this study. Among 250 patients, 52 (20.8%) patient had single vessel disease (SVD), 49 (19.6%) and 149 (59.6%) had double vessel disease (DVD) and triple vessel disease (TVD) respectively. ARAS was detected in 37.2% or 93 patients. ARAS tends to increase with age. In age group of 30-40, ARAS is 7.4% whereas in age group of 51-60 years it is 41%. The incidence of ARAS is high in 50.25±9.98years; p=0.0001. 33.3% male patients with CAD had ARAS whereas it was 44.3% in female patients with CAD. ARAS is more common in female 44.3% vs 33.3%; p=0.02. ARAS prevalence increased with the number of stenosed coronary arteries (3.8% in 1-vessel, 26.5% in 2-vessel, 52.3%in 3-vessel CAD; p=.0001.). Hypertension and angiographically proven CAD were independent predictors of ARAS (p=0.0001). In conclusion, ARAS prevalence and severity increases with the number of arterial territories involved and CAD severity. Hypertension and 2-3-vessel-CAD were identified independent predictors of ARAS.  doi:10.3329/uhj.v4i2.2069 University Heart Journal Vol. 4 No. 2 July 2008 p24-27

Renal artery stenosis

Fibromuscular dysplasia (FMD) and aortoarteritis are the most frequent causes of secondary hypertension induced by renal artery stenosis (RAS). Revascularization of this disease entity usually cures arterial hypertension. Demographic evolution leads to an increasing incidence of atherosclerotic RAS, one of the major causes of end-stage renal failure. Furthermore, atherosclerotic RAS leads to deterioration of primary hypertension, progression of atherosclerosis manifestation such as occlusive and aneurysmatic peripheral artery disease, and chronic or acute organ damage such as left ventricular hypertrophy and recurrent flash pulmonary edema. Despite the lack of sufficiently powered randomized controlled trials, each hemodynamically relevant RAS (eg, > or = 70%) should be considered for stent angioplasty in patients without end-stage ischemic nephropathy or limited life expectancy due to concomitant disease (eg, cancer). Drug-eluting stents will probably reduce the overall low in-stent restenosis rate of 10% to 20%. Interventions in patients with dialysis-dependent end-stage nephropathy are left to appropriate clinical study protocols.

Prevalence and Risk Factors of Atherosclerotic Renal Artery Stenosis in 1,200 Chinese Patients Undergoing Coronary Angiography

Aims: Atherosclerotic renal artery stenosis (ARAS) is a common and potentially reversible cause of end-stage renal failure. Our study aimed to determine the prevalence and predictors of ARAS in Chinese patients undergoing coronary angiography for suspected coronary heart disease (CAD), or for acute or chronic myocardial infarction. Methods: Selective renal arteriography was performed immediately after coronary angiography in 1,200 consecutive patients. Medical history and laboratory data were obtained before the procedure. Significant renal artery stenosis was defined as ≧50% narrowing of the luminal diameter. Uni- and multivariate logistic regression analyses were made to explore the association of the clinical and laboratory variables, including some items which had never or rarely been studied, with ARAS or CAD. Results: Of the 1,200 patients, 840 were male and 360 female. Their mean age was 62 ± 10 years. Low-grade (<50%) and significant coronary artery stenosis was found in 108 (9%) and 610 (51%) patients respectively. By multivariate logistic regression analysis, risk factors associated with the presence of coronary artery stenosis included male, older age, smoking, high serum concentration of low density lipoprotein, lipoprotein (a), and fast blood glucose ≧7.0 mmol/l. Significant ARAS was present in 116 (9.7%) patients, of which 20 (1.7%) were bilateral. The incidence of ARAS was similar in patients with suspected CAD or myocardial infarction. Multivariate logistic regression analysis showed the association of the clinical variables with ARAS included: older age, hypercholesterolemia, a more than 10-year history of hypertension, proteinuria and S_Cr ≧133 µmol/l. The severity of ARAS is significantly related to the severity of coronary artery disease. Conclusion: ARAS is a frequent finding in Chinese patients undergoing coronary angiography, especially in patients with significant coronary artery stenosis and risk factors for ARAS. Renal arteriography can be a helpful examination in these patients.