A18643 A Prospective, randomized trial to compare effects of intensive versus conventional lipid-lowering therapy in patients with severe atherosclerotic renal artery stenosis undergoing stent placement

Abstract

Objectives: To compare the renal-protective effect of intensive lipid lowering with that of conventional lipid lowering in patients with severe atherosclerotic renal artery stenosis (ARAS) undergoing stent placement. Methods: 150 patients with severe ARAS undergoing stent placement were randomly (1:1) assigned to receive intensive lipid lowering (Target LDL-C < 1.8mmol/L) or conventional lipid lowering (Target LDL-C ≥1.8mmol/L, < 3.3mmol/L). All patients received rosuvastatin. We adjusted LDL-C to the goal within two months after renal stenting and maintained stable. The primary end point was the change of eGFR at 12 months. Results: During the study period LDL-C was lower in the patients with intensive lipid lowering than with conventional lipid lowering [At 12 months (1.49 ± 0.26) vs (2.24 ± 0.40) mmol/L, p < 0.001]. At 12-month follow-up, eGFR [(91.8 ± 30.17) vs (78.52 ± 19.45) mL/(min 1.73 m2), p = 0.002] and the increase of eGFR compared to baseline [14.83 (IQR,4.1,26.71) vs − 0.43 (IQR, −9.54,7.99)mL/(min 1.73 m2), p < 0.001] were higher in the patients with intensive lipid lowering than with conventional lipid lowering. Urinary albumin-creatinine ratio [42.15 (IQR,20.01,60.85) vs 50 (IQR,31,127) mg/g, p = 0.032] was lower and the decrease of urinary albumin-creatinine ratio compared to baseline [27.44 (IQR,3.04,53.8) vs −3.05 (IQR, −17.28,30.94) mg/g, p = 0.001] were higher in the patients with intensive lipid lowering than with conventional lipid lowering. The restenosis rate (3.1% vs 3.4%, p = 0.711) and major clinical events (6.8% vs 11.0 %, p = 0.37) were similar between the two groups. Conclusion: In patients with severe ARAS undergoing stent placement, intensive lipid lowering showed significant benefits in renal protection over conventional lipid lowering therapy.