How important and how treatable is vascular stiffness as a cardiovascular risk factor in renal failure?

It is possible, with the increasing recognition and repetition of epidemiological data that provide compelling evidence for the appalling toll that cardiovascular (CV) pathology exerts on patients with advanced renal failure, to become both blasé and nihilistic. Dialysis patients aged 20–30 years have the same cardiovascular mortality (CVM) as non-diabetic non-uraemic subjects aged 70–80! Despite the known high prevalence of coronary artery disease in dialysis patients w1x, assessment of CV risk relying exclusively on ‘conventional’ CV risk factors incompletely explains these patents’ greatly increased mortality rates. Where Framingham CVM risk scores and actual CV events have been compared (in a renal transplant population) it appears that age, diabetes and smoking seem even more Correspondence and offprint requests to: Dr David J. A. Goldsmith, Consultant Nephrologist, Renal Unit, Guy’s Hospital, London SE1 9RT, UK. Email: [email protected] 965 Nephrol Dial Transplant (2002) 17: Editorial Comments