Statin May Lower Risk of CV Events, Death Among HD Patients

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VANCOUVER, B.C.—Statin treatment may decrease the risk of cardiovascular (CV) events and all-cause mortality in hemodialysis (HD) patients, according to researchers.

A post-hoc analysis of data from the AURORA trial showed that normalizing levels of high-sensitive C-reactive protein (hsCRP) and low-density lipoprotein cholesterol (LDL-C) with rosuvastatin was associated with a 47% decreased risk of major CV events, a 46% decreased risk of CV death, and a 29% decreased risk of death from any cause, investigators reported at the World Congress of Nephrology.

AURORA (A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) was a randomized, double-blind, placebo-controlled study of patients aged 50-80 years and who had been treated with regular HD or hemofiltration for three or more months. Subjects were randomized to receive either rosuvastatin 10 mg daily or placebo, with follow-up visits at three months after randomization and then every six months. The mean duration of study treatment and follow-up was 2.4 and 3.2 years, respectively.

The post-hoc analysis, by Bengt Fellström, MD, of Uppsala University Hospital in Uppsala, Sweden, and colleagues, examined whether or not patients achieved hs-CRP levels below 2.0 mg/L and/or LDL-C levels below 67 mg/dL at three and/or 12 months following randomization. The primary endpoint was time to first major CV event (CV death, non-fatal myocardial infarction, or stroke).

Of the 2,776 patients randomized into AURORA, 813 had hsCRP levels below 2.0 mg/L after three and/or 12 months of treatment, 1,418 had LDL-C below 67 mg/dL, and 509 had both hsCRP below 2.0 mg/L and LDL-C below 67 mg/dL, Dr. Fellström's team reported.

LDL-C was not a risk factor for CV events in the study population as whole but in the 813 patients who achieved hsCRP levels below 2.0 mg/L, higher baseline LDL-C emerged as a significant risk factor for major CV events, according to the researchers. In contrast, among patients who only achieved hsCRP levels of 2.0 mg/L or higher, higher baseline LDL-C was associated with decreased risk.

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