Pravastatin and cardiovascular risk in moderate chronic kidney disease

Abstract

Objectives To investigate the relation between chronic kidney disease (CKD) and cardiovascular disease (CVD) and retrospectively to evaluate the effect of low dose of pravastatin in Japanese hypercholesterolemic patients with CKD enrolled in the large-scale randomized MEGA Study. Methods In this post hoc analysis, effect of low dose pravastatin treatment (10–20 mg daily) on the primary prevention of the cardiovascular disease and renal function after 5 years was evaluated in 7196 patients with normal kidney function/mild CKD or moderate CKD. Patients were classified based on an estimated glomerular filtration rate (eGFR) ≥60 or 30–<60 mL/min/1.73 m 2 as having normal renal function/mild CKD or moderate CKD, respectively. Since Japanese guidelines do not allow statin use in patients with severe kidney disease, such individuals were excluded. Results The incidence of CVD events was 35–49% higher in patients with moderate CKD than in those with normal renal function/mild CKD. Notably, in the moderate CKD group pravastatin significantly reduced CHD by 48% ( P = 0.02), stroke by 73% ( P < 0.01), CVD by 55% ( P < 0.01), and total mortality by 51% ( P = 0.02). Moreover, the change in eGFR during follow-up in patients with moderate CKD was significantly ( P = 0.03) higher in those assigned to receive diet plus pravastatin (+6.3%) compared with those on diet alone (+5.1%). Conclusions Risk of CVD is higher in patients with moderate CKD compared with those with normal renal function/mild CKD, and was significantly reduced by treatment with pravastatin. Pravastatin also exerted beneficial effects on renal function in patients with moderate CKD.