By Maggie Schwarz
PHILADELPHIA -- November 7, 2008 -- In patients with chronic kidney disease (CKD), the use of statin drugs does not prevent loss of kidney function but it does prevent acute cardiovascular (CV) events, according to research presented here at Renal Week 2008, the American Society of Nephrology (ASN) annual meeting.
The results were obtained from a post-hoc analysis of the Primary Prevention of Acute Coronary Events With Lovastatin in Men and Women With Average Cholesterol Levels-Results of the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPs/TexCaps), a randomized, double-blind trial of 5,608 men and 997 women without clinically evident CV disease who were followed for 5 years.
In their analysis of AFCAPs/TexCaps, Jessica Kendrick, MD, University of Colorado, Denver Health Sciences Center, Aurora, Colorado, and colleagues evaluated the effects of lovastatin on the incidence of major acute CV events in patients with CKD and no clinically evident cardiovascular disease.
In a presentation on November 6, Dr. Kendrick reported the results on 2,137 patients with CKD, defined as an estimated glomerular filtration rate (GFR) <60 mL/min/1.73 m2 as calculated using the Modification of Diet in Renal Disease equation.
Compared with patients that did not have CKD, patients with CKD were significantly older, were more likely to be female, had a higher prevalence of hypertension, had higher levels of total and low-density lipoprotein cholesterol, and used beta-blockers, calcium channel blockers, diuretics, and angiotensin-converting enzyme inhibitors more frequently.
The primary endpoint was the occurrence of incident acute coronary events, defined as fatal and nonfatal myocardial infarction, unstable angina, or sudden cardiac death.
After they adjusted for patient demographics, comorbidities, and laboratory tests, the researchers found that lovastatin use in patients with CKD was associated with lower rates of the composite endpoint compared with patients without CKD. Patients with CKD treated with lovastatin had an adjusted relative risk (RR) of acute coronary events of 0.39 (95% confidence interval [CI], 0.16-0.93; P = .03).
Compared with placebo, CKD patients treated with lovastatin had significantly lower rates of first cardiac events, including coronary events (RR, 0.62; 95% CI, 0.44-0.88; P = .007), CV events (RR, 0.66; 95% CI, 0.48-0.90; P = .01), and coronary revascularization procedures (RR, 0.60; 95% CI, 0.41-0.90; P = .01).
No significant reduction in the incidence of myocardial infarction, unstable angina, total mortality, fatal CV events, or fatal coronary events was seen in patients with CKD taking lovastatin.
For the composite CV endpoint, the treatment effect of lovastatin appeared to be greater in patients with baseline CKD.
Lovastatin did not reduce the rate of kidney function loss or the risk of incident CKD (8.8 vs 8.3%) compared with placebo. There was no difference in the annualized mean rate of decline in estimated GFR in those who received lovastatin compared with those taking placebo (1.5 +- 4.6 vs 1.6 +- 4.3 mL/min/1.73 m2 per year, respectively).
Dr. Kendrick concluded that lovastatin is effective for primary prevention of acute coronary events in patients with CKD.
Funding for this study was provided by Merck Research Laboratories.
[Presentation title: Lovastatin for Primary Prevention of Acute Coronary Events in Persons With Chronic Kidney Disease. Abstract TH-PO885]
E-Mail this DGDispatch to a colleague
