Guía de práctica clínica para el diagnóstico, manejo y control de dislipidemia, complicaciones renales y oculares en personas con Diabetes Mellitus tipo 2 / Clinical practice guideline for the diagnosis, management and control of dyslipidemia, renal and ocular complications in people with type 2 Diabetes Mellitus

Contribuir a la disminución de las enfermedades cardiovasculares debido a dislipidemia, la enfermedad renal crónica terminal y la ceguera por retinopatia diabética de las personas com diabete mellittus tipo 2.

Dislipidemia Diabética / Diabetic Dyslipidemia

O Diabetes mellitus é uma doença com elevada prevalência global, associada à mortalidade cardiovascular e complicações microvasculares, que conferem o caráter crônico a essa patologia. No diabetes tipo II, o processo aterosclerótico tem início antes mesmo do diagnóstico, daí a importância do reconhecimento dos fatores de risco implicados na fisiopatologia da doença vascular nessa população. A dislipidemia no diabético é caracterizada por lipoproteínas ricas em triglicérides, LDL pequenas, densas e muito aterogênicas e HDL-c baixo. As estatinas são os medicamentos de escolha para tratar a dislipidemia e reduzir de forma significativa o risco cardiovascular nesses pacientes. Apesar do controle glicêmico intensivo não reduzir eventos cardiovasculares nos estudos randomizados, alguns hipoglicemiantes apresentam efeito favorável sobre o perfil lipídico, com redução de futuros eventos

Diabetes mellitus is a disease with high global prevalence, associated with cardiovascular mortality and microvascular complications, which give this disease its chronic nature. In type II diabetes, the atherosclerotic process begins even before diagnosis, hence the importance of recognizing the risk factors involved in pathophysiology of vascular disease in this population. Dyslipidemia in the diabetic patient is characterized by triglyceride-rich lipoproteins; small-dense and very atherogenic LDLs and low HDL-c. Statins are the drugs of choice for treating dyslipidemia and significantly reducing the cardiovascular risk in these patients. Although intensive glycemic control did not reduce cardiovascular events in randomized trials, some hypoglycemic drugs have demonstrated a favorable effect on the lipid profile, and may reduce future events

Predictive capacity of anthropometric indicators for dyslipidemia screening in children and adolescents / Capacidade preditiva de indicadores antropométricos para o rastreamento da dislipidemia em crianças e adolescentes

ABSTRACT OBJECTIVE: To analyze the predictive capacity of anthropometric indicators and their cut-off values for dyslipidemia screening in children and adolescents. METHODS: This was a cross-sectional study involving 1139 children and adolescents, of both sexes, aged 6-18 years. Body weight, height, waist circumference, subscapular, and triceps skinfold thickness were measured. The body mass index and waist-to-height ratio were calculated. Children and adolescents exhibiting at least one of the following lipid alterations were defined as having dyslipidemia: elevated total cholesterol, low high-density lipoprotein, elevated low-density lipoprotein, and high triglyceride concentration. A receiver operating characteristic curve was constructed and the area under the curve, sensitivity, and specificity was calculated for the parameters analyzed. RESULTS: The prevalence of dyslipidemia was 62.1%. The waist-to-height ratio, waist circumference, subscapular, body mass index, and triceps skinfold thickness, in this order, presented the largest number of significant accuracies, ranging from 0.59 to 0.78. The associations of the anthropometric indicators with dyslipidemia were stronger among adolescents than among children. Significant differences between accuracies of the anthropometric indicators were only observed by the end of adolescence; the accuracy of waist-to-height ratio was higher than that of subscapular (p = 0.048) for females, and the accuracy of waist circumference was higher than that of subscapular (p = 0.029) and body mass index (p = 0.012) for males. In general, the cut-off values of the anthropometric predictors of dyslipidemia increased with age, except for waist-to-height ratio. Sensitivity and specificity varied substantially between anthropometric indicators, ranging from 75.6 to 53.5 and from 75.0 to 50.0, respectively. CONCLUSIONS: The anthropometric indicators studied had little utility as screening tools for dyslipidemia, especially in children.

RESUMO OBJETIVO: Analisar a capacidade preditiva dos indicadores antropométricos e os seus valores de corte para a triagem da dislipidemia em crianças e adolescentes. MÉTODOS: Estudo transversal de 1.139 crianças e adolescentes de ambos os sexos entre 6 e 18 anos. Peso corporal, estatura, circunferência da cintura (CC) e prega cutânea subescapular (PCSE) e prega cutânea tricipital (PCT) foram medidos. O índice de massa corporal (IMC) e a relação cintura-estatura (RCE) foram calculados. As crianças e os adolescentes que tinham pelo menos uma das seguintes alterações lipídicas foram definidos como tendo dislipidemia: elevados níveis de colesterol total, HDL-C baixo, LDL-C elevado e concentração elevada de triglicérides. Uma curva ROC (Receiver Operating Characteristics) foi construída e a área sob a curva, a sensibilidade e a especificidade foram calculadas para os parâmetros analisados. RESULTADOS: A prevalência de dislipidemia foi de 62,1%. RCE, CC, PCSE, IMC e PCT, nessa ordem, apresentaram o maior número de precisões significativas e variaram de 0,59-0,78. As associações dos indicadores antropométricos com dislipidemia foram mais fortes nos adolescentes do que nas crianças. Diferenças significativas entre precisões dos indicadores antropométricos só foram observadas no fim da adolescência. A precisão da RCE foi maior do que a da PCSE (p = 0,048) para meninas e a precisão de CC foi maior do que a PCSE (p = 0,029) e IMC (p = 0,012) para os meninos. Em geral, os valores de corte dos preditores antropométricos de dislipidemia aumentaram com a idade, exceto para RCE. Sensibilidade e especificidade variaram substancialmente entre os indicadores antropométricos, de 75,6-53,5 e 75,0-50,0, respectivamente. CONCLUSÕES: Os indicadores antropométricos estudados mostraram pouca utilidade como ferramentas de rastreamento para dislipidemia, especialmente em crianças.

Dislipidemia autorreferida na região Centro-Oeste do Brasil: prevalência e fatores associados / Self-reported dyslipidemia in central-west Brazil: prevalence and associated factors

As dislipidemias são fatores de risco para a doença aterosclerótica e seu controle poderá reduzir a morbidade hospitalar e a mortalidade por doença arterial coronariana. O objetivo do artigo é estimar a prevalência de dislipidemias e identificar fatores associados. Estudo de corte transversal de base populacional com dados individuais do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL). Foram incluídos 7.975 indivíduos de ambos os sexos, com idade ≥ 18 anos, residentes nas capitais dos estados da Região Centro-Oeste do Brasil, no ano de 2009. As associações foram estimadas por meio da regressão de Poisson. A prevalência de dislipidemia foi de 15%, crescente com a idade (p = < 0,01) e não diferiu significativamente quanto ao sexo. Após ajustes, as variáveis que se associaram diretamente com o desfecho foram: sobrepeso (p = < 0,01), obesidade (p = < 0,01) e a autoavaliação do estado de saúde ruim (p = < 0,01). O consumo regular de feijão (≥ 5 dias/semana) associou-se inversamente com a prevalência de dislipidemias (p = < 0,01). A prevalência de dislipidemia na Região Centro-Oeste foi crescente com a idade e associada ao consumo de feijão, excesso de peso (sobrepeso e obesidade) e autoavaliação do estado de saúde ruim.

Lipid disorders are risk factors for atherosclerotic disease and its control may reduce morbidity and mortality from coronary artery disease. Knowledge of the factors associated with this injury may subsidize campaigns to encourage change in the population's lifestyle. The objective of this study is to estimate the prevalence of dyslipidemia and to identify associated factors. Cross-sectional population-based study, with individual data from the Telephone Survey on Risk Factors and Protection for Chronic Diseases Surveillance System (VIGITEL). It included 7,975 individuals of both sexes, aged ≥ 18 years living in state capitals in the central-west of Brazil, in the year 2009. Associations were estimated using Poisson regression. The prevalence of dyslipidemia was 15%, increased with age (p = < 0.01) did and not differ significantly according to sex. After adjustments, the variables that were directly associated with the outcome were overweight (p = < 0.01), obesity (p = < 0.01) and self-rated health as poor (p = < 0.01). Regular consumption of bean (≥ 5 days/week) was inversely associated with the prevalence of dyslipidemia (p = < 0.01). The prevalence of dyslipidemia in the central-west of Brazil was increased with age and was associated with bean consumption, excess weight (overweight and obesity) and self-rated health as poor.

Prevalencia de factores de riesgo de enfermedad cardiovascular en niños y adolescentes con infección por HIV / Prevalence of risk factors for cardiovascular disease in HIV-infected children and adolescents

Introducción: La exposición prolongada a las drogas en el tratamiento antirretroviral de alta eficacia (HAART) cambió el pronóstico de la enfermedad pero puede generar alteraciones metabólicas y lipodistrofia que aumentan el riesgo de enfermedad cardiovascular precoz (ECVP). En la población pediátrica infectada con HIV los estudios son escasos y las medidas para disminuir el riesgo de ECVP no han sido definidas. Objetivo: investigar la prevalencia de factores de riesgo de ECVP en niños y adolescentes con infección crónica por HIV en un hospital pediátrico de alta complejidad. Material y Métodos: estudio descriptivo, prospectivo, controlado, de corte transversal. Se incluyeron niños con infección vertical por HIV, edad entre 2 y 18 años estratificados según esquema de tratamiento antirretroviral recibido (con y sin Inhibidores de la Proteasa-IP-) y controles seronegativos. Se realizó antropometría, impedanciometría bioeléctrica (BIA)y ecodoppler carotídeo. Se dosó glucemia basal, insulina basal, perfil lipídico, TGO, TGP, recuento de leucocitos y plaquetas, linfocitos TCD4+ y TCD8+, carga viral, proteína C Reactiva cuantitativa de alta sensibilidad. Se consideraron pacientes con riesgo de ECVP a los que presentaron: obesidad, hipertensión arterial, intolerancia a la glucosa/ diabetes, resistencia a la insulina, dislipemia, aumento de proteína C reactiva (PCR) o aumento del grosor arterial. Resultados: Ambos grupos HIV+ presentaron un escore Z para peso, talla y BMI significativamente menor que el grupo control., mientras que la frecuencia de aparición del índice Cintura/Talla con valores patológicos fue significativamente mayor en el grupo HIV+. Utilizando el método clínico de Carr el 18% de los pacientes HIV+ presentaba lipodistrofia, la mayoría de los cuales tenían hipertrigliceridemia. El grupo HIV+ presento un% de masa grasa (MG) mayor y un% de masa libre de grasa (MLG) y masa celular menor que el grupo control medido por BIA. Se constató alta prevalencia de dislipidemia en el grupo HIV+ con niveles medios más altos de Colesterol total, c-LDL, y TG que el grupo control, que fue significativamente mayor en los pacientes expuestos a IP con valores más elevados de colesterol total y c-LDL y mayor frecuencia de alteración del índice CT/HDL y significativamente mayor en el grupo expuesto a IP. No se encontraron diferencias de los niveles medios de glucemia en ayunas, insulina basal ni resistencia a la insulina evaluada por HOMA. En el subgrupo HIV+ estudiado se observó un aumento del espesor de la íntima media carotidea. Conclusión: En un grupo de niños y adolescentes infectados verticalmente por HIV bajo TARV de alta eficacia el peso, talla,% de MLG y MC fue significativamente menor y el% de MG mayor que el grupo control. La alta prevalencia de dislipidemia encontrada en el grupo HIV+, particularmente en aquellos expuestos a IP y el indice Cintura/Talla constituyen factores que aumentarían el riesgo de desarrollar enfermedad cardiovascular precoz (AU)

Introduction: Long-term drug exposure using highly active antirretroviral therapy (HAART) has changed disease prognosis in HIV-infected patients, but may cause metabolic alterations and lipodystrophy increasing the risk of early cardiovascular disease (ECVD). Studies in the population of HIV-infected children are scarce and measures to reduce the risk of ECVD have not been defined. Aim: To investigate the prevalence of risk factors for ECVD in children and adolescents with a chronic HIV-infection in a tertiary pediatric. Material and Methods: A descriptive, prospective, controlled cross-sectional study was conducted. Children with a mother-to-child HIV infection between 2 and 18 years of age, stratified according to HAART regimen received (with or without protease inhibitors (PI)) and seronegative controls were included. Anthropometry, bioelectrical impedance analysis (BIA), and carotid ultrasonography were performed. Baseline glycemia and insulin, lipid profile, ALT, AST, leukocyte and platelet counts, TCD4+ and TCD8+ lymphocytes, viral load, and high-sensitivity quantitative C-reactive protein (CRP) were measured. Patients were considered at high risk for ECVD when they had: obesity, arterial hypertension, glucose intolerance/diabetes, insulin resistance, dyslipidemia, increased CRP, or increased intima-media thickness. Results: Both HIV+ groups presented with significantly lower Z-scores for weight, height, and BMI than the control group, while the prevalence of pathological measures of waist-to-height index was significantly higher in the HIV+ group. Using the clinical method of Carr, 18% of the HIV+ patients presented with lipodistrophy, the majority of whom had hypertriglyceridemia. The HIV+ group had a higher percentage of fat mass (FM) and a lower percentage of fat-free mass (FFM) and cell mass (CM) than the control group measured by BIA. A high prevalence of dyslipidemia was found in the HIV+ group with higher mean total cholesterol, LDLcholesterol, and TG levels than in the control group. This prevalence was significantly higher in patients receiving PI, with increased levels of total cholesterol and LDL-cholesterol and a higher rate of alteration of the total cholesterol/HDL ratio. No differences were found in mean fasting glycemia, baseline insulin, or insulin resistance levels assessed using HOMA. In the HIV+ PI subgroup, increased carotid intima-media thickness was observed. Conclusion: In a group of vertically HIV-infected children on HAART, weight, height, percentage of FFM and CM were significantly lower and percentage of FM was significantly higher than in the control group. The high prevalence of dyslipidemia found in the HIV+ group, particularly in those exposed to PI, as well as the higher waist-to-height index increase the risk of developing ECVD (AU)

Nutritional profile of asymptomatic alcoholic patients / Perfil nutricional de pacientes alcoólatras assintomáticos

CONTEXT: Alcoholism may interfere with nutritional status, but reports are often troubled by uncertainties about ingested diet and organ function, as well as by ongoing abuse and associated conditions. OBJECTIVE: To identify nutritional and body compartment changes in stable alcoholics without confounding clinical and dietetic variables, a prospective observational pilot study was designed. Three well-matched populations were considered: subjects with chronic alcoholic pancreatitis, alcoholics without visceral disease, and healthy never-drinking adults (controls). METHODS: Subjects (n = 60) were asymptomatic males with adequate diet, no superimposed disease or complication, and alcohol-free for at least 6 months. After exclusions, 48 patients were compared. Variables encompassed dietary recall, bioimpedance analysis, biochemical profile and inflammatory markers. Main outcome measures were body fat, lean body mass, serum lipids, C-reactive protein, and selected minerals and vitamins. RESULTS: Both alcoholic populations suffered from reduced lean body mass (P = 0.001), with well-maintained body fat.Magnesium was depleted, and values of vitamin D and B12 correlated with alcohol abuse. LDL and total cholesterol was increased in alcoholics without pancreatitis (P = 0.04), but not in those with visceral damage. C-reactive protein and serum amyloid A correlated with duration of excessive drinking (P = 0.01). CONCLUSIONS: Undernutrition (diminished lean body mass, risk of magnesium and vitamin deficiencies) contrasted with dyslipidemia and increased cardiovascular risk. This second danger was masked during chronic pancreatitis but not in alcoholics without visceral disease. Further studies should focus special requirements of this population.

CONTEXTO: O alcoolismo pode interferir no estado nutricional, todavia, os relatos frequentemente sofrem com o viés das incertezas sobre dieta consumida, danos orgânicos subjacentes e persistência do abuso. OBJETIVO: Para identificar alterações nutricionais e de compartimentos corpóreos em alcoólatras estáveis sem variáveis de confusão clínica e dietética, foi desenhado o presente estudo piloto observacional prospectivo. Três populações bem pareadas foram consideradas: casos de pancreatite crônica alcoólica, alcoólatras sem enfermidade visceral e adultos que nunca consumiram etanol (controles). MÉTODOS: Os pacientes (n = 60) eram homens assintomáticos com dieta satisfatória, nenhuma evidência de enfermidade ou complicação exceto as do protocolo e afastados do etanol por no mínimo 6 meses. Após exclusões, 48 pacientes foram comparados. As variáveis abrangeram recordatório alimentar, análise de bioimpedância, perfil bioquímico e marcadores inflamatórios. Os principais resultados buscados foram gordura corporal, massa magra, lípides séricos, proteína C reativa e vitaminas e minerais selecionados. RESULTADOS: Os dois grupos que ingeriam álcool exibiram redução da massa magra (P = 0,001) com gordura corporal bem conservada. O magnésio estava diminuído e as taxas de vitamina D e B12 se correlacionaram com o abuso de álcool. O colesterol total e LDL estavam aumentados nos alcoólatras sem pancreatite (P = 0,04), porém, não naqueles com dano pancreático. A proteína C reativa e o seroamilóide A correlacionaram-se com a duração do excesso etílico (P = 0,01). CONCLUSÕES: A desnutrição (menor massa magra, possibilidade de carência de magnésio e vitaminas) contrastou com a dislipidemia e o risco cardiovascular elevado. Este segundo perigo permaneceu mascarado na vigência de pancreatite crônica, porém, não nos alcoólatras sem lesão visceral. Estudos adicionais deverão focalizar as necessidades nutricionais específicas desta população.

Prevalência dos fatores de risco cardiovasculares nos pacientesatendidos no ambulatório de geriatria da UNESC / Prevalence of Cardiovascular Risk Factors in Elderly Patients – South Brazil

Objetivo: Conhecer a prevalência de fatores de risco cardiovasculares nos pacientes atendidos no Ambulatóriode Geriatria da Universidade do Extremo Sul Catarinense (UNESC) entre os anos de 2005 e 2007. Método: Foi realizado um estudo transversal, documental,descritivo, retrospectivo, de abordagem quantitativa, onde foram analisados 120 prontuários de pacientes idosos que foram atendidos entre o período demarço de 2005 e setembro de 2007, no Ambulatório de Geriatria da UNESC. As variáveis coletadas foram: idade, sexo e raça, presença de hipertensão arterial e diabete melito, níveis de HDL-c, LDL-c, colesterol total e triglicerídeo, valor do IMC, presença de história familiarpara doenças cardiovasculares, e prática de atividade física regular.Resultados: A prevalência dos fatores de risco analisados foi de: sedentarismo 80%, história familiar positiva para DAC 76,7%, HAS 72,5%, obesidade 37,5%,DM 26,7%, tabagismo 6,7%, alterações nos níveis de HDL-c 19,8%, LDL-c 34,2%, colesterol total 27% e triglicerídeos 18,8%. Conclusões: A prevalência dos fatores de risco paraDAC na população de idosos atendidos no Ambulatório de Geriatria da UNESC é, de maneira geral, elevada, e as categorias associadas como fator de risco foram: mulheres, raça negra e a faixa etária entre 60 e 69 anos.Dentre os fatores de risco modificáveis, o sedentarismo foi o que apresentou a maior prevalência, seguido pela presença de história familiar positiva para DAC, HAS, obesidade, dislipidemia, DM, e, por fim, tabagismo.

Aim: To know the prevalence of cardiovascular risk factors in patients investigated in Geriatric Ambulatoryfrom Extreme South of Santa Catarina University (UNESC) between 2005 and 2007. Methods: It was realized a descriptive, retrospective, transversal study, where it was analyzed 120 records of elderly patients followed between March 2005 and September 2007, in Geriatric Ambulatory of UNESC.The collected variables were: age, sex, race, blood hypertension, and diabetes mellitus (DM); HDL-c, LDL-c, totalcholesterol and triglycerides levels; BMI value, familial history of cardiovascular disease and regular physical activity practice. Results: The prevalence of cardiovascular risk factors was: sedentarism 80%, familial history of cardiovascular disease 76,7%, blood hypertension 72,5%, obesity 37,5%, DM 26,7%, smoking 6,7%, HDL-c levelslow 19,8%, LDL-c 34,2%, total cholesterol 27% and triglycerides18,8%. Conclusions: The prevalence of cardiovascular risk factors in this population is high, and categories associated with these risk factors were women, black people and age between 60-69 years old. Among risk factorsthat can be modified, the sedentarism was the most prevalent, followed by familial history of cardiovascular disease, blood hypertension, obesity, dyslipidemia, DM and smoking.

Clinical and nutritional profile of individuals with chagas disease

Chagas disease (CD), caused by the protozoan Trypanossoma cruzi, affects approximately 18 million individuals in the Americas, 5 million of which live in Brazil. Most chronic sufferers have either the indeterminate form of the disease, without organic compromise, or the cardiac or digestive forms. Despite the importance of this disease, there is no information on the effect of nutrition on CD evolution. We evaluated the clinical-nutritional profile of individuals with CD treated at the Tropical Diseases Nutrition Out-Patient Clinic of the Botucatu School of Medicine, UNESP. A retrospective cohort study was performed between 2002 and 2006, on 66 patients with serum and parasitological diagnosis of CD. Epidemiological, clinical, nutritional, and biochemical data were collected, including gender, age, skin color, smoking, alcoholism, physical activity, weight, stature, body mass index, abdominal circumference, glycemia, and lipid profile. Fifty-three percent were male and 47 percent female; 96 percent were white skinned. Mean age was 49.6±6.36 years. The predominant form was indeterminate in 71 percent; smoking and drinking were recorded in 23 percent and 17 percent, respectively. Sedentariness predominated in 83 percent, and 55 percent presented increased abdominal circumference. Most, 94 percent, were overweight or obese. The biochemical exams revealed hyperglycemia in 12 percent and dyslipidemia in 74 percent. These findings suggest that the Chagas population presents co-morbidities and risk factors for developing chronic non-transmissible diseases, including cardiovascular diseases, making CD evolution even worse.

Dislipidemia na doença renal crônica / Dyslipidemia in chronic kidney disease

As alterações do metabolismo dos lípides são parte integrante da síndrome urêmica e ocorrem em cerca de 70% dos pacientes com doença renal crônica. O perfil lipídico típico da doença renal crônica difere daquele observado na população geral e caracteriza-se por níveis normais de colesterol total e de colesterol de lipoproteína de baixa densidade (LDLcolesterol), redução do colesterol de lipoproteína de alta densidade (HDL-colesterol) e aumento das partículas ricas em triglicerídeos, como lipoproteína de muito alta densidade (VLDL) e lipoproteína de densidade intermediária (IDL). Esse perfil lipídico apresenta comprovado potencial aterogênico e é provável que desempenhe papel importante na alta prevalência de doença cardiovascular associada à uremia. O mecanismo da dislipidemia da doença renal crônica não é bem conhecido, mas acredita-se que resistência à insulina, aumento do estresse oxidativo e alterações na estrutura e na função das apolipoproteínas sejam os fatores mais importantes. Apesar do grande número de trabalhos sobre o assunto, ainda não existem provas definitivas de que a dislipidemia aumente o risco cardiovascular em renais crônicos e de que o tratamento com estatinas reduza significativamente esse risco. Mesmo com essa ressalva, as diretivas internacionais e nacionais recomendam o uso de estatinas na doença renal crônica, seguindo as mesmas regras observadas para pacientes com doença cardiovascular. Espera-se que estudos, já em curso, especificamente concebidos para avaliar o papel das estatinas na prevenção de eventos cardiovasculares na doença renal crônica possam em breve contribuir para o melhor planejamento terapêutico da doença renal.

Lipid alterations are an integral part of the uremic syndrome, occurring in roughly 70% of patients with chronic kidney disease. Typical lipid profile associated with chronic kidney disease differs substantially from that observed in the general population and is characterized by normal total- and low density lipoprotein cholesterol (LDL-cholesterol), reduced high density lipoprotein cholesterol (HDL-cholesterol) and increased levels of triglyceride-rich particles, like very low density lipoprotein (VLDL) and intermediate density lipoprotein (IDL). This lipid profile exhibits substantial atherogenic potential and probably plays a significant role in the increased prevalence of cardiovascular disease associated with chronic uremia. The mechanism of the lipid abnormalities observed in chronic kidney disease is not well known but insulin resistance, increased oxidative stress and alterations in the structure and function of apolipoproteins are believed to be involved. In spite of the great number of investigations on the subject, there is still no conclusive proof that dyslipidemia increases the cardiovascular risk of chronic kidney disease patients and that this risk is significantly reduced by statins. However, despite these considerations, national and international guidelines recommend prescription of statins to chronic kidney disease patients following the same rules observed for individuals of the general population with established cardiovascular disease. It is expected that a number of trials, already in course, specifically designed to verify the preventive role of statins on cardiovascular events in chronic kidney disease, would clarify this important subject in near future.