Pravastatin and cardiovascular risk in moderate chronic kidney disease

Nakamura, Haruo; Mizuno, Kyoichi; Ohashi, Yasuo; Yoshida, Tomowo; Hirao, Koichi; Uchida, Yasufumi

doi:10.1016/j.atherosclerosis.2009.03.031

Cited by 76 publications

(66 citation statements)

References 20 publications

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“…A subanalysis of the MEGA study in 2,210 patients with diabetes or impaired fasting glucose demonstrated that treatment with low-dose pravastatin significantly reduced the relative risk of CVD events by 32% (HR, 0.68; 95% CI, 0.48-0.96) 110) . Similarly, a post-hoc analysis of the MEGA study, in which 7,196 patients were stratified by CKD status at baseline, demonstrated that low-dose pravastatin significantly reduced the relative risk of CHD events by 48% (HR, 0.52; 95% CI, 0.31-0.89; p = 0.02) and CVD events by 55% (HR, 0.45; 95% CI, 0.30-0.69; p＜0.01) in those patients with moderate CKD 111) . Owing to the limited availability of clinical data in Japanese patients with diabetes and/or CKD, information on the CV benefit of statin therapy in these high-risk groups may be inferred from studies of other Asian populations.…”

Section: Effects On Cardiovascular Diseasementioning

confidence: 99%

“…However, in the SHARP study, while allocation to ezetimibe plus simvastatin produced a significant reduction in major atherosclerotic events in patients with baseline microalbuminuria (urinary albumin : creatinine ratio, ≥ 30-≤ 300 mg/g; HR, 0.75; 95% CI, 0.57-0.97) or baseline proteinuria (urinary albumin : creatinine ratio, ＞300 mg/g; HR, 0.72; 95% CI, 0.57-0.91), combination therapy did not produce significant reductions in progression to ESRD or doubling . patients with moderate CKD assigned to receive diet plus pravastatin 10-20 mg/day (6.3% increase) than in those on diet alone (5.1% increase; p = 0.03) 111) . Several small studies have investigated the effects of statin therapy on kidney function.…”

Section: Effects On Kidney Function In Renal Transplant Recipientsmentioning

confidence: 99%

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Statin Use in Patients with Diabetes and Kidney Disease: The Japanese Experience

Koya

Campese

2013

JAT

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Diabetes is a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in developed nations, including Japan and the United States. Japan has the unenviable distinction of having one of the world's highest rates of dialysis: in 2011, there were over 300,000 dialysis patients (2,383 per million people), with diabetic patients accounting for almost half of all incident cases. Concomitance of CKD and diabetes predicts a greater risk of cardiovascular disease (CVD) than either condition in isolation. Hence, appropriate management of modifiable cardiovascular (CV) risk factors, including dyslipidemia, is paramount in this high-risk group. The United States and Japan have distinct approaches to cholesterol management, with more stringent therapeutic targets for lipid control advocated in US guidelines. However, upward trends in cholesterol levels and coronary heart disease incidence in Japan may provide justification for more intensive CV risk factor management strategies by Japanese physicians to achieve maximum benefit. Attainment of recommended lipid goals in Japan is poor, particularly in patients with diabetes and/or CKD in whom CV risk factors are often undertreated. Statin therapy has been shown to be safe and effective in reducing CV risk in patients with diabetes and/or CKD stages 1-5. Moreover, statins may impart a renoprotective effect by preventing or delaying progressive loss of kidney function. This review summarizes evidence from studies in Western and Japanese populations to highlight the CV and renal benefits of lipid-lowering agents in CKD patients, including those with diabetes. J Atheroscler

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Section: Effects On Cardiovascular Diseasementioning

confidence: 99%

Section: Effects On Kidney Function In Renal Transplant Recipientsmentioning

confidence: 99%

Statin Use in Patients with Diabetes and Kidney Disease: The Japanese Experience

Koya

Campese

2013

JAT

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“…A meta-analysis 78) supports the notion that statins protect against the decline of renal function. Increased eGFR was also reported for Japanese patients with hypercholesterolemia 69,82) .…”

Section: Possible Reno-protective Effects Of Lipid-lowering Treatmentmentioning

confidence: 86%

“…In a meta-analysis 68) , treatment with fluvastatin significantly reduced the risk for combined cardiac death and myocardial infarction by 41% as compared with a placebo in the subgroup with creatinine clearance (CCr) ＜50 mL/min, the relative risk reduction being greater than 30% in the subgroup with CCr ≥ 50 mL/min. Furthermore, the sub-analysis of MEGA in Japan 69) , pravastatin treatment reduced the risk for coronary heart disease, stroke, combined CVD events, and total mortality by 48%, 73%, 54% and 52%, respectively as compared with diet therapy alone. The relative risk reductions in CKD patients were much better than in total subjects.…”

Section: Lipid-lowering Treatment and Risk For Cvd In Ckd Stage 5dmentioning

confidence: 99%

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Chronic Kidney Disease, Dyslipidemia, and Atherosclerosis

Shoji

Abe

Matsuo³

et al. 2012

JAT

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Patients with chronic kidney disease (CKD) are at an increased risk not only for end-stage kidney disease (ESKD) but also for cardiovascular disease (CVD). In this review article, we summarize the current evidence of CKD as a high-risk condition for CVD based on reports from Japan and other countries to draw attention to the close clinical association between CKD and CVD. Several epidemiologic studies have shown that the presence of CKD and reduced renal function are independent predictors of CVD also in Japan. According to a post-hoc analysis of CASE-J, the power of CKD as a predictor of CVD is as strong as diabetes mellitus and a previous history of ischemic heart disease. CKD worsens classical risk factors including hypertension and dyslipidemia, and dyslipidemia is associated with increased thickness and stiffness of large arteries independent of major confounders. A post-hoc analysis of MEGA indicates that lipid-lowering therapy with statins reduces the risk of CVD, and that it appears to be more efficacious in patients with than without CKD. These reports from Japan and other countries suggest that CKD should be regarded as a high-risk condition comparable to diabetes mellitus, and that strict control of dyslipidemia would be beneficial in preventing CVD, at least early stages of CKD.

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Statins, Mortality, and Major Adverse Cardiovascular Events Among US Veterans With Chronic Kidney Disease

Barayev,

Hawley,

Wellman

et al. 2023

JAMA Netw Open

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ImportanceThere are limited data for the utility of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) and death in adults with chronic kidney disease (CKD).ObjectiveTo evaluate the association of statin use with all-cause mortality and major adverse cardiovascular events (MACE) among US veterans older than 65 years with CKD stages 3 to 4.Design, Setting, and ParticipantsThis cohort study used a target trial emulation design for statin initiation among veterans with moderate CKD (stages 3 or 4) using nested trials with a propensity weighting approach. Linked Veterans Affairs (VA) Healthcare System, Medicare, and Medicaid data were used. This study considered veterans newly diagnosed with moderate CKD between 2005 and 2015 in the VA, with follow-up through December 31, 2017. Veterans were older than 65 years, within 5 years of CKD diagnosis, had no prior ASCVD or statin use, and had at least 1 clinical visit in the year prior to trial baseline. Eligibility criteria were assessed for each nested trial, and Cox proportional hazards models with bootstrapping were run. Analysis was conducted from July 2021 to October 2023.ExposureStatin initiation vs none.Main Outcomes and MeasuresPrimary outcome was all-cause mortality; secondary outcome was time to first MACE (myocardial infarction, transient ischemic attack, stroke, revascularization, or mortality).ResultsIncluded in the analysis were 14 828 veterans. Mean (SD) age at CKD diagnosis was 76.9 (8.2) years, 14 616 (99%) were men, 10 539 (72%) White, and 2568 (17%) Black. After expanding to person-trials and assessing eligibility at each baseline, there were 151 243 person-trials (14 685 individuals) of nonstatin initiators and 2924 person-trials (2924 individuals) of statin initiators included. Propensity score adjustment via overlap weighting with nonparametric bootstrapping resulted in covariate balance, with mean (SD) follow-up of 3.6 (2.7) years. The hazard ratio for all-cause mortality was 0.91 (95% CI, 0.85-0.97) comparing statin initiators to noninitiators. The hazard ratio for MACE was 0.96 (95% CI, 0.91-1.02). Results remained consistent in prespecified subgroup analyses.Conclusions and RelevanceIn this target trial emulation of statin initiation in US veterans older than 65 years with CKD stages 3 to 4 and no prior ASCVD, statin initiation was significantly associated with a lower risk of all-cause mortality but not MACE. Results should be confirmed in a randomized clinical trial.

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Pravastatin and cardiovascular risk in moderate chronic kidney disease

Cited by 76 publications

References 20 publications

Statin Use in Patients with Diabetes and Kidney Disease: The Japanese Experience

Statin Use in Patients with Diabetes and Kidney Disease: The Japanese Experience

Chronic Kidney Disease, Dyslipidemia, and Atherosclerosis

Statins, Mortality, and Major Adverse Cardiovascular Events Among US Veterans With Chronic Kidney Disease

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