[Treatment of Hypercholesterolemia in Chronic Kidney Disease: Rationale and Therapeutic Approaches from the Non-Dialysis Stage to Kidney Transplantation].

Throughout the natural history of chronic kidney disease (CKD), most patients experience fatal or non-fatal cardiovascular events. In this review, we address the role of low-density lipoprotein cholesterol (LDL-C) in the excess cardiovascular risk associated with CKD and examine the impact of both traditional and novel LDL-C-lowering therapies across the entire spectrum of CKD. Current guidelines for the prevention of atherosclerotic cardiovascular disease (ASCVD), developed by European and US cardiology societies, recommend assessment of overall cardiovascular risk to tailor the intensity of preventive strategies to the individual patient's risk profile: the higher the cardiovascular risk, the more intensive the intervention should be. Novel therapies have demonstrated efficacy in achieving lower LDL-C targets, which are often unattainable with conventional treatment. The identification of vulnerable coronary plaques, rather than the mere presence of vascular lumen narrowing, represents a promising imaging target for guiding intensified preventive strategies in high-risk populations, including patients with CKD. In CKD, cardiovascular risk progressively increases as kidney function declines. Despite clear recommendations from both nephrology and non-nephrology guidelines, initiation, maintenance, and intensification of lipid-lowering treatment, as well as achievement of LDL-C targets, remain suboptimal in the CKD population. As novel lipid-lowering therapies provide additional therapeutic options for patients with CKD, there is now a compelling need to increase awareness of cardiovascular risk and integrate lipid management into the broader, longitudinal care of patients with CKD across all stages of the disease.