The Effects of Statins on the Progression of Atherosclerotic Renovascular Disease

Abstract

Background/Aims: The aim was to examine the influence of statin therapy on the natural history of atherosclerotic renal artery stenosis (RAS). Methods: Our hospital atherosclerotic renovascular disease (ARVD) database was analysed for patients who underwent repeat renal angiography during clinical follow-up. Patients with ≧1 RAS lesion and ≧4 months between baseline and repeat renal angiography were analysed. 79 patients were included. Baseline renal arterial anatomy was classified as normal, ≤50% RAS, >50% RAS or renal artery occlusion. Results: Mean follow-up time between angiograms was 27.8 ± 22.3 (4.0–101.9) months. Progression of RAS occurred in 28 (23%) vessels, regression in 14 (12%) and no significant change in 79 (65%). Multivariate regression analysis showed that baseline proteinuria >0.6 g/day increased the risk of progressive disease (relative risk, RR, 3.8; 95% confidence interval, CI, 1.2–12.1), treatment with statin reduced the risk of progression (RR 0.28; 95% CI 0.10–0.77). 14 renal arteries from 12 patients showed RAS regression with a greater proportion on statin [statin treatment 10 (83%) versus no statin treatment 2 (17%), p = 0.001]. Change in estimated glomerular filtration rate (eGFR) per year was not different between statin- and no-statin-treated groups. Conclusions: Progression or development of RAS was significantly less likely to occur with statin therapy. ΔeGFR did not correlate with progression of RAS, reflecting the importance of intrarenal injury in the aetiology of renal dysfunction. Our results suggest statin therapy can alter the natural history of ARVD.

Atherosclerotic Renovascular Disease: Epidemiology and Clinical Manifestations

“…Other studies have shown increased levels of free-fatty acids (glycerol-glyceride) in patients with ARVD [ 48 ], though this may have more important implications for mortality than development of atheroma [ 49 ]. However, intervention with statins has been shown to prevent anatomical progression of RAS in a retrospective study, which provides some support to the pathogenic effect of hypercholesterolemia in renal atherogenesis [ 50 ].…”

“…These fi gures are only of historical interest in the current era of statin therapy. Although available data are retrospective, in a study of 79 patients with ARVD, statin treated patients (n = 40) were much less likely to suffer progression of stenosis at 3-years (odds ratio 0.28, p = 0.01) than non-statin treated patients [ 50 ] (Fig. 1.2 ).…”

Revascularization as a treatment to improve renal function

“…Treatment with angiotensin blockade 23,24 and lipid-lowering therapy 25 is accepted as a minimum standard of care, and there is consensus that other vascular risk reduction measures should be applied. Given differences in medical therapy within and between published RCT data, direct comparison between studies is not practical.…”

Diagnosis and treatment of renal artery stenosis

“…a retrospective study of serial angiography has shown that the use of statins actually reduces the risk of progression of atherosclerotic ras. 16 another…”