LDL-cholesterol lowering and renal outcomes.

CE: Alpana; MOL/26304; Total nos of Pages: 5; MOL 26304 REVIEW URRENT C O PINION LDL-cholesterol lowering and renal outcomes David D. Waters Purpose of review Patients with chronic kidney disease (CKD) are at high risk for cardiovascular events. Statins reduce cardiovascular risk in a broad spectrum of patients. This article summarizes the evidence that statins reduce risk in CKD patients, and that statins have a small but favorable effect on renal function. Current guidelines for lipid management in patients with CKD are also reviewed. Recent findings Two well conducted randomized trials showed no significant benefit for statins among patients receiving dialysis. One large trial demonstrated that simvastatin/ezetimibe reduced cardiovascular events in a broad spectrum of CKD patients. A recent meta-analysis concluded that CKD patients benefit from statins, and that the relevant benefit decreases as the severity of CKD worsens. In large trials, statin-treated patients have slightly less worsening of renal function overtime, and there are data to suggest that statins actually do not only preserve, but also increase renal function. Recent guidelines recommend a statin for CKD patients aged 50 years or older, for younger patients with known vascular disease, diabetes, or a 10-year risk greater than 10%, and for adult renal transplant recipients. Summary Statins should be prescribed to older patients with CKD, and to younger patients with CKD who are at high CVD risk. Keywords cardiovascular risk, cholesterol, chronic kidney disease, dialysis, statins INTRODUCTION Cardiac disease and renal disease are closely linked. They often coexist, and each can cause or negatively influence the other. For example, patients with renal failure often develop heart failure, and severe heart failure induces important renal adaptations. Risk factors such as diabetes and hypertension are common to cardiac and renal disease. Lipid lowering, documented mainly with sta- tins, reduces cardiovascular events across a broad spectrum of patients at risk, including those with chronic kidney disease (CKD). The effects of lipid lowering on renal outcomes and renal function have been less well documented. These topics form the subject of this article. patients receiving hemodialysis. The German Dia- betes and Dialysis Study (4D ) randomized 1255 AQ2 patients with type 2 diabetes on maintenance hemo- dialysis to atorvastatin 20 mg/day or placebo and followed them for a median of 4 years [1]. Atorvas- tatin lowered LDL-C by 42%, but the primary com- posite endpoint, comprising death from cardiac causes, nonfatal myocardial infarction (MI) and stroke, was not reduced (relative risk 0.92, 95% CI AQ3 0.77–1.10, P ¼ 0.37). AQ4 In A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA), 2776 patients receiving maintenance hemodialysis were randomized to receive rosuvastatin 10 mg/day or placebo, and were followed for a median of 3.8 years EFFECT OF STATINS ON CARDIOVASCULAR OUTCOMES IN PATIENTS WITH CHRONIC KIDNEY DISEASE Division of Cardiology, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA The effect of statins on cardiovascular outcomes in patients with CKD varies according to the stage of CKD. In two randomized, placebo-controlled trials statins did not reduce cardiovascular endpoints in Correspondence to David D. Waters, MD, Division of Cardiology, Room 5G1, San Francisco General Hospital, 1100 Potrero Avenue, San Francisco, CA 94114, USA. Tel: +1 415 420 6646; e-mail: David.Wat ers@ucsf.edu Curr Opin Lipidol 2015, 26:000–000 DOI:10.1097/MOL.0000000000000176 0957-9672 Copyright s 2015 Wolters Kluwer Health, Inc. All rights reserved. www.co-lipidology.com AQ1