Statins reduce atherosclerotic risk in patients with kidney disease
MedWire News: Reducing levels of low-density lipoprotein (LDL) cholesterol lowers the risk for atherosclerotic events in patients with chronic kidney disease, findings from the SHARP trial suggest.
The researchers found that lowering LDL cholesterol levels with simvastatin plus ezetimibe was associated with a 17% reduction in major atherosclerotic events, compared with placebo.
"These benefits are substantial and suggest that widespread use of LDL cholesterol-lowering therapy in patients with chronic kidney disease would result in a worthwhile reduction in cardiovascular disease complications in this high-risk population," comments the team in The Lancet.
The SHARP (Study of Heart and Renal Protection) trial included 9270 patients with chronic kidney disease; 3023 on dialysis and 6247 not on dialysis. Patients were randomly assigned to receive simvastatin 20 mg plus ezetimibe 10 mg daily (n=4650) or placebo (n=4620).
The primary endpoint was first major atherosclerotic event, including nonfatal myocardial infarction or coronary death, nonhemorrhagic stroke, or any arterial revascularization procedure.
Colin Baigent (University of Oxford, UK) and colleagues say that allocation to simvastatin plus ezetimibe reduced mean LDL cholesterol levels by 0.85 mmol/l (32.82 mg/dl) over the mean 4.9-year follow up.
Among participants receiving simvastatin plus ezetimibe, a total of 526 first major atherosclerotic events were reported compared with 619 among those receiving placebo. This corresponded to a 17% proportional reduction in major atherosclerotic events, which the researchers say is "equivalent to a one-fifth risk reduction per mmol/l reduction in LDL cholesterol."
Rates of coronary revascularizations were most affected, with simvastatin plus ezetimibe treatment being associated with a 27% reduction in risk compared with placebo.
The proportional effect on major atherosclerotic events was similar in patients on dialysis and in those who were not, notes the team.
In an accompanying commentary Kathryn Stevens and Alan Jardine, from the University of Glasgow in the UK, said: "Patients with chronic kidney disease have an increased risk for premature kidney disease, but the routine exclusion of patients with chronic kidney disease from cardiovascular or other interventional studies means that we have limited information on which to base treatment decisions and guidelines."
Thus, the results of the SHARP trial "are pertinent to everyone who treats patients with chronic kidney disease," they concluded.
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By Nikki Withers