Emerging Vascular Risk Factors In Atherosclerotic Renal Artery Stenosis

Hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, old age and family history are established risk factors for the development of atherosclerotic renal artery stenosis (ARAS). Besides these, however, several emerging risk factors have been proposed in the last few years to be predictors of ARAS. These include homocysteine, fibrinogen, C-reactive protein (CRP), lipoprotein (a) and creatinine. A search of the MEDLINE database was performed for studies investigating the role of each of these emerging risk factors as predictors of ARAS. There is accumulating evidence that CRP and creatinine may be the most promising predictors of ARAS. Current data for the prognostic value of homocysteine, lipoprotein (a), and fibrinogen is not yet adequate to support a prognostic role for these emerging risk factors in ARAS. The impact of establishing of a definite role for these emerging risk factors is not negligible. Identification of accurate predictors for A RAS could result in earlier recognition and better management of the disease with potential regression (or slowing down of progression) of stenosis. Future trials may help establish guidelines regarding the effect of different classes of drugs (e.g. statins and fibrates) on the levels of the emerging risk factors and the association with ARAS progression.