Kidney Stones and Heart Attacks, Strokes, or CHF (congestive heart failure)

The link between kidney stones and heart disease and stroke is being increasingly established by research. One large study has shown that people with stones have a 19 percent increased risk of heart disease and a 40 percent increased risk of stroke. The risk is more in women than men for unexplained reasons. Lifestyle modifications such as a healthy diet, regular exercise, smoking cessation, and weight loss can help prevent both kidney stones and vascular events like heart attack and stroke.

Treatment of kidney stones in a person with vascular disease can be complex and requires consultation with a cardiologist and urologist who will decide on which treatment option is optimal. People with heart disease are often on blood-thinning drugs such as aspirin, Coumadin (warfarin), and Plavix (clopidogrel). This can complicate the decision-making process. It may not be possible to safely perform a kidney stone procedure while a patient is on a blood thinner due to a high risk of bleeding. It is not always possible to take a patient with a history of heart disease or stroke off their blood thinner due to a risk of clot formation. The urologist and cardiologist will need to decide if and when to stop any blood thinners if a patient is taking them.

In terms of treatment options, it should be noted that the risk of bleeding is highest after shock wave lithotripsy and PCNL and lower after ureteroscopy. Typically, if it is determined by the cardiologist and urologist that a patient cannot come off their anticoagulant for a prolonged period of time, ureteroscopy is often the preferred treatment option.

In patients with a history of heart problems, medical expulsion therapy (allowing the patient to pass the stone) may not always be the most prudent option since it can put stress on the heart. The treatment is individualized to each patient. The therapy plan is developed by the patient’s cardiologist and urologist who decide whether the patient can be allowed to pass the stone or whether the patient will benefit from surgical intervention sooner. Treatment options for patients with cardiac problems are, again, ESWL, ureteroscopy, and PCNL.

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