Effect on non-vascular outcomes of lowering LDL cholesterol in patients with chronic kidney disease: results from the Study of Heart and Renal Protection

BMC Nephrology

Research Article

L. Jiang¹  T. Pedersen²  A. Cass³  N. Staplin⁴  W. G. Herrington⁴  C. Reith⁴  J. Armitage⁴  W. Stevens⁴  M. J. Landray⁴  M. Mafham⁴  C. Baigent⁵  R. Haynes⁵  J. Emberson⁵  J. C. Craig⁶ 

[1] Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China;Centre of Preventive Medicine, Oslo University Hospital, Oslo, Norway;Faculty of Medicine, University of Oslo, Oslo, Norway;Menzies School of Health Research, Charles Darwin University, Darwin, Australia;Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK;Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK;Medical Research Council-Population Health Research Unit (MRC-PHRU), NDPH, University of Oxford, Oxford, UK;Sydney School of Public Health, University of Sydney, Sydney, Australia;

关键词: Chronic Kidney Disease;    Simvastatin;    Statin Therapy;    Ezetimibe;    Albumin Creatinine Ratio;   

DOI  :  10.1186/s12882-017-0545-2

 received in 2016-08-24, accepted in 2017-04-01,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundReducing LDL cholesterol (LDL-C) with statin-based therapy reduces the risk of major atherosclerotic events among patients with chronic kidney disease (CKD), with no evidence of an excess risk of cancer or death from any non-vascular cause. However, non-randomized data have suggested that statin therapy may have effects (both adverse and beneficial) on particular non-vascular conditions that do not cause death.MethodsThe Study of Heart and Renal Protection (SHARP) randomized patients with CKD to simvastatin 20 mg plus ezetimibe 10 mg (simvastatin/ezetimibe) daily versus matching placebo. Participants were followed up at least 6 monthly and all post-randomization serious adverse events (SAEs) were recorded. This supplementary analysis reports the effects of treatment on non-vascular SAEs, overall, by system of disease, by baseline characteristics, and by duration of follow-up.ResultsDuring a median of 4.9 years follow-up, similar numbers of participants in the two groups experienced at least one non-vascular SAE (3551 [76.4%] simvastatin/ezetimibe vs 3537 [76.6%] placebo; risk ratio [RR] 0.99, 95% confidence interval [CI] 0.95–1.04). There was no good evidence of any significant effect of simvastatin/ezetimibe on SAEs attributed to any particular nonvascular disease system (of 43 comparisons, only 3 yielded an uncorrected p value < 0.05, of which the smallest was p = 0.02). The relative risk of any nonvascular SAE did not vary significantly among particular prognostic subgroups or by duration of follow-up.ConclusionsIn the SHARP trial, allocation to simvastatin/ezetimibe combination therapy was not associated with any significant non-vascular hazard.Trials registrationSHARP was retrospectively registered after the first participant was enrolled in 2003 at ISRCTN (ISRCTN54137607 on 31 January 2005: http://www.isrctn.com/ISRCTN54137607) and ClinicalTrials.gov (NCT00125593 on 29 July 2005: https://clinicaltrials.gov/ct2/show/NCT00125593).

【 授权许可】

CC BY   
© The Author(s). 2017