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Clinical Opal #14 - CVD risk and statins in patients with CKD

17 June 2022 - Dr Simon Morgan

He brought along a health summary from his previous GP which listed his past medical history as CKD, hypertension and gout. His medications are irbesartan 150mg daily and allopurinol 100mg daily. Graeme does not smoke and has minimal alcohol intake. Graeme does not identify as Aboriginal or Torres Strait Islander. At the initial visit, his BP was recorded as 132/72. 

You are seeing him for review after blood tests which show:

  • eGFR 58 mL/min/1.73m
  • Chol 4.6 (3.9-5.2)  mmol/L                                       
  • Trig 1.8  (0.5-1.7)  mmol/L            
  • HDL 1.1 (1.0-2.0)  mmol/L                                       
  • LDL 2.8  (1.5-3.4)  mmol/L                               

There is no microalbuminuria.

You calculate Graeme’s absolute cardiovascular risk at 9% using the Australian absolute CVD risk calculator.


Based on his medical history and CV risk, should Graeme be offered a statin?

According to the recently published Chronic Kidney Disease (CKD) Management in Primary Care guidance (2020), despite his relatively modest 5 year CV risk, Graeme SHOULD be offered a statin.

In relation to CKD and CVD, there is strong evidence that both reduced eGFR and significant albuminuria are independent risk factors for CVD. The guidelines state that CKD is a more important risk factor for CVD than diabetes, and that even early-stage CKD constitutes a significant risk factor for CV events and death. They recommend a CV risk assessment be performed on adults without existing cardiovascular from age 45 years (and from age 35 years for Aboriginal and Torres Strait Islander people). 

 NOTE: Adults already known to be at increased absolute risk of CVD (including moderate or severe CKD [macroalbuminuria, and/or eGFR <45] and diabetes with microalbuminuria) do not need a CV risk assessment performed.

 More specifically, in terms of lipid management, the guidelines state that a statin should be offered to all patients aged ≥50 years with any stage of CKD, irrespective of lipid levels. This should be done in a shared decision model of care.

 

Hot Topics

The management of CKD, as with Graeme above, is a continually evolving field, and is one of the many clinical updates as part of the 2022 Hot Topics course. Join us from the comfort of your own home on Saturday 25 June for our next Hot Topics GP Update. This course is run in partnership with NB Medical (UK) and aims to update GPs with the latest developments in primary care to help you deliver better patient care.

The course revolves around short, engaging presentations that merge recent clinical evidence with real-life clinical scenarios.

And like all Medcast courses, all content is completely independent and free of external influence. 

Click here to find out more about Hot Topics. We look forward to seeing you there!

Dr Simon Morgan
Dr Simon Morgan

Simon is a GP based in Newcastle, NSW, and a senior medical educator with Medcast.  He also has medical education roles with the RACGP and GPSA.

Over the past three decades, Simon has worked in clinical and educational roles in NSW and the NT, as well as in the Republic of Ireland. He has published over 75 peer reviewed journal articles, and in 2018 received the RACGP Corliss award for his contribution to medical education.

Simon is passionate about high quality education and training. He has particular interests in GP supervisor professional development and the rational use of tests and medicines. He is a proud member of Doctors for the Environment. He spends his spare time drinking craft beer and pretending that he is a musician in the Euthymics, an all-GP band.

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