The burden of cardiovascular disease in patients with kidney disease: temporal trends & treatment gaps (Dr Peter Gallacher)

Cardiovascular disease (CVD) is inextricably linked with kidney disease and is its commonest complication. Historic data indicate that CVD risk increases as renal function declines, although reasons for this are unclear.

Recent diagnostic and therapeutic advances have improved the incidence and outcomes of acute coronary syndrome (ACS) in the general population, but contemporaneous trends in ACS in dialysis and renal transplant patients, who are at the greatest CVD risk, have not been evaluated. The Fellow will perform two population-based studies utilising high-fidelity linked healthcare data unique to Scotland.

Study 1 will investigate 30-year trends in the incidence and outcomes of ACS, including rates of secondary prevention prescribing, in dialysis and renal transplant patients.

Study 2 will better characterise the relationship between renal function and CVD risk, uniquely including patients with both acute and chronic kidney disease, in a contemporaneous, unselected and representative cohort of >500,000 patients using routine biochemistry and clinical data.

It will explore modifiable discrepancies in preventative therapy prescribing in patients with kidney disease and compare how treatment efficacy – in terms of CVD risk – varies in patients with and without renal dysfunction. This work will highlight opportunities for targeting CVD treatments in patients with kidney disease.