Stephen L. Seliger, MD, acting professor of medicine, nephrology division, University of Washington, Seattle, Washington, and colleagues compared cardiovascular outcomes in 2074 patients with CRI who had used simvastatin and 1391 patients with CRI who had not used simvastatin but in whom statin therapy was indicated. Indications for statin treatment included prevalent vascular disease or low-density lipoprotein (LDL)-cholesterol greater than 130 mg/dL.

"While simvastatin treatment has been shown to be effective for primary and secondary cardiovascular prevention in the general population, randomized studies of statins have historically excluded patients with moderate and severe renal insufficiency despite the fact that this population has high rates of cardiovascular disease," Dr. Seliger explained. "On the other hand, these patients tend to have slightly different lipid abnormalities that may not necessarily make doctors consider treating them with statins so they have had relatively low rates of stain therapy."

All subjects were Medicare-insured veterans with chronic kidney disease. The trial excluded transplant and dialysis patients.

Results show that the cumulative survival rate at 4 years was 69% in simvastatin versus 61% in non-users. Simvastatin users had a 22% lower rate of death after adjustment for multiple potential confounders over a median of 2.5 years of follow-up. The association with lower mortality did not differ by baseline renal function.

No association between simvastatin and myocardial infarction, stroke, percutaneous transluminal coronary angioplasty PTCA, coronary bypass surgery was observed in the study population during follow-up.

Dr. Seliger suggested that the lack of association between simvastatin use and vascular events might be due to the short follow-up time or a competing risk with all cause mortality.

"The main clinical message is that statins should be used in patients with chronic kidney disease who need them, since there is now some evidence for their benefit with regards to mortality," he said.

The study was supported by Merck, Inc.


[Presentation title: "Simvastatin Use and Cardiovascular Outcomes Among Veterans With Chronic Renal Insufficiency (CRI)." Abstract F-P0273]

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