Effect of statins versus untreated dyslipidemia on serum uric acid levels in patients with coronary heart disease: a subgroup analysis of the greek atorvastatin and coronary-heart-disease evaluation (GREACE) study

Athyros, Vasilios G.; Elisaf, Moses; Papageorgiou, Athanasios A.; Symeonidis, Athanasios; Pehlivanidis, A.; Bouloukos, Vasilios I.; Milionis, H. J.; Mikhailidis, Dimitri P.

doi:10.1053/j.ajkd.2003.12.023

Cited by 200 publications

(163 citation statements)

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“…[12][13][14] There are now several reports on the effects of statins (mainly atorvastatin and simvastatin) on renal function and SUA levels as well as their contribution to CHD risk reduction. 8,9,[15][16][17][18][19] ACEIs (Group A and C) had a neutral effect on renal function and SUA levels ( Table 2). These differences in renal function may have influenced the RRRs.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8][9] Only patients with established CHD were included: history of prior myocardial infarction or 470% stenosis of at least one coronary artery, as documented by a coronary angiogram. Patients with recent acute coronary syndromes were not excluded.…”

Section: Original Studymentioning

confidence: 99%

“…We report on-study treatment in Table 3 according to this information. There were no significant differences between the four treatment groups in demographic characteristics and CHD factors at baseline (Table 1), in baseline lipid values and renal function (Table 2), in concomitant drug treatment during the study (Table 3), and level of glycemic control [6][7][8][9] or in blood pressure during the study (Table 2). Both at entry and during the study, smokers were similarly distributed in the four treatment groups.…”

Section: Other Factors That May Have Influenced Clinical Outcomesmentioning

confidence: 99%

“…Both at entry and during the study, smokers were similarly distributed in the four treatment groups. [6][7][8][9] All patients in the four treatment groups received advice on life-style changes and the body mass index (an approximate index of compliance) at baseline and during the study was similar in all groups. Thus, the beneficial effect on clinical outcomes should mainly be attributed to statin or ACEI treatment or both.…”

Section: Other Factors That May Have Influenced Clinical Outcomesmentioning

confidence: 99%

“…The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study [6][7][8][9] was a prospective, randomised, target based, open-label and intention-to-treat secondary CHD prevention trial. GREACE showed that the structured management of dyslipidaemia with dose titration of atorvastatin can achieve the National Cholesterol Educational Program (NCEP) low-density lipoprotein cholesterol (LDL-C) treatment goal (o2.6 mmol/l;100 mg/dl).…”

Section: Introductionmentioning

confidence: 99%

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Effect of statins and ACE inhibitors alone and in combination on clinical outcome in patients with coronary heart disease

et al. 2004

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We assessed the 'synergy' of statins and angiotensinconverting enzyme inhibitors (ACEI) in reducing vascular events in patients with coronary heart disease (CHD). The GREek Atorvastatin and CHD Evaluation (GREACE) Study, suggested that aggressive reduction of low density lipoprotein cholesterol to 2.59 mmol/l (o100 mg/dl) significantly reduces morbidity and mortality in CHD patients, in comparison to undertreated patients. In this post hoc analysis of GREACE the patients (n ¼ 1600) were divided into four groups according to long-term treatment: Group A (n ¼ 460 statin þ ACEI), B (n ¼ 420; statin, no ACEI), C (n ¼ 371;no 371;no statin, on ACEI), and D (n ¼ 349; no statin, no ACEI). Analysis of variance was used to assess differences in the relative risk reduction (RRR) in 'all events' (primary end point) between groups. During the 3-year follow-up there were 292 cardiovascular events; 45 (10% of patients) in group A, 61 (14.5%) in group B, 91 in group C (24.5%) and 95 events in group D (27%). The RRR (95% confidence interval (CI) in the primary end point in group A was 31%, (95% CI À48 to À6%, P ¼ 0.01) in comparison to group B, 59% (95% CI À72 to À48%, Po0.0001) to group C and 63% (95% CI À74 to À51%, Po0.0001) to group D. There was no significant difference in RRR between groups C and D (9%, CI À27-10%, P ¼ 0.1). Other factors (eg the blood pressure) that can influence clinical outcome did not differ significantly between the four treatment groups. In conclusion, the statin þ ACEI combination reduces cardiovascular events more than a statin alone and considerably more than an ACEI alone. Aggressive statin use in the absence of an ACEI also substantially reduced cardiovascular events. Treatment with an ACEI in the absence of a statin use reduced clinical events in comparison to patients not treated with an ACEI but not significantly, at least in these small groups of patients.

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