Statins Not Renoprotective
In a post-hoc analysis of a large double-blind, randomized trial, Jessica Kendrick, MD, of the Division of Renal Diseases and Hypertension, University of Colorado at Denver, and her colleagues compared the effect of lovastatin and placebo in 6,604 subjects without clinical evidence of CVD at baseline.
The researchers divided the cohort into two groups: those with CKD—defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2—and those without (eGFR of 60 and above). The CKD and non-CKD groups comprised 304 and 6,300 subjects, respectively. The mean baseline eGFR was 53.3 in the CKD group and 88.8 in the non-CKD group, respectively. In the CKD group, 145 patients received lovastatin and 159 received placebo. In the non-CKD group, 3,158 patients received lovastatin and 3,142 received placebo.
In CKD patients, lovastatin use was associated with a significant 61% reduced risk of the composite cardiovascular end point compared with placebo recipients, after adjusting for demographics, comorbidities, and laboratory tests, Dr. Kendrick's group reported here at during the American Society of Nephrology's Renal Week conference.
The composite end point encompassed various cardiovascular events, including coronary death, MI, unstable angina, and coronary revascularization procedures.The investigators observed no significant decrease in the incidence of MI, unstable angina, overall mortality, fatal CV events, or fatal coronary events in CKD patients receiving lovastatin.
“Physicians should increase the use of statins in CKD patients at risk for cardiac disease to reduce the burden of CVD in this patient population,” the authors concluded.
Compared with placebo, lovastatin did not decrease the rate of renal function loss, which was defined as a 25% or greater decrease in eGFR from baseline, or the risk of developing incident CKD. “At this time, the use of statins solely for primary renoprevention is not recommended,” the researchers noted.