Statins cut vascular events in kidney disease

Prescribing cholesterol-lowering drugs for kidney disease would slash cases of MI, stroke and vascular surgery, UK research suggests.

CKD patients on statins saw LDL cholesterol fall by 1mmol/L
CKD patients on statins saw LDL cholesterol fall by 1mmol/L

Treating 1,000 patients with simvastatin plus ezetimibe would lead to 21 fewer cases of a major atherosclerotic event, according to researchers from the Oxford University.

Experts heralded the findings as ‘compelling evidence’ for lipid-lowering therapy in chronic kidney disease (CKD).

Professor Colin Baigent of Oxford University, who led the Study of Heart and Renal Protection (SHARP) trial, said the results were good news for kidney patients.

He said: ‘Reducing cholesterol long-term would avoid around one quarter of heart attacks, strokes and operations to unblock arteries, leading to their prevention in at least 250,000 people with kidney disease worldwide each year.'

CKD affects one in ten people in the UK and half of all aged over 75 to some degree.

The condition increases the chance of cardiovascular disease. Although previous studies had hinted at the benefit of statins to reduce the risk, little is known about whether this is safe or effective.

Researchers randomly allocated 9,270 patients to either simvastatin 20mg plus ezetimibe 10mg daily or placebo.

Over nearly five years follow-up, patients on statins plus ezetimibe saw LDL cholesterol fall by 1mmol/L – around seven times more than those on placebo.

Results showed 13.4% of patients on placebo had a non-fatal MI, coronary death, non-haemorrhagic stroke or surgery to unblock arteries.

This compared with 11.3% among patients on statins plus ezetimibe – a relative risk reduction of 17%.

Researchers found a slight excess risk of myopathy among patients on statins plus ezetimibe, but there was no evidence of increased risk of hepatitis, gallstones or cancer, or death from an non-vascular cause.

They noted that clinicians could also opt for statin monotherapy instead to obtain similar outcomes to the simvastatin/ezetimibe combination.

Researchers from the British Heart Foundation’s Cardiovascular Research Centre at the University of Glasgow welcomed the ‘eagerly awaited’ results.

Dr Kathryn Stevens and Professor Alan Jardine, both of the institute, noted there was no survival benefit or renal protective effect observed in the study.

But they added: ‘Noneless, there is a clear message from SHARP: lipid lowering has significant benefits in CKD, specifically the prevention of atherosclerotic events’.

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