Abstract
BackgroundLittle is known about the potential of statin-induced high-density lipoprotein cholesterol (HDL-C) increase to improve renal function in coronary heart disease (CHD) patients.Methods and Results In thispost hocanalysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study we investigated the effect of HDL-C increase after statin treatment on renal function. From a total of 1,600 patients, 880 were on various statins (mainly atorvastatin) and 720 were not. Other secondary prevention therapies were similar in the 2 groups. After a 3 year follow up, the lipid profile was unchanged in the statin untreated group and estimated glomerular filtration rate (eGFR) was reduced by 5.1% compared with baseline (P<0.0001). In contrast, in the statin treated group non-HDL-C was reduced by 43%, HDL-C was increased by 7% and there was a significant increase in eGFR compared with baseline by 9.8% (P<0.0001). In multiple regression analysis, the mean 7% increase in HDL-C in the treated arm during the entire study was associated with a 5.6% increase in eGFR recorded after the 6th week of treatment. The odds ratio of eGFR increase with every 5% statin-induced rise in HDL-C was 1.78 (95% confidence interval 1.19-3.34; P=0.001).ConclusionsStatin treatment significantly improved renal function. Statin-induced HDL-C increase significantly and independently contributed to this improvement. This finding supports the concept that improving lipid variables other than low density lipoprotein cholesterol is also beneficial to preserving renal function.
Highlights
Chronic kidney disease (CKD), including mild renal impairment, is recognized as an independent predictor of cardiovascular disease (CVD) in high-risk patients [1,2,3]
In our statin untreated patients, there was a gradual reduction in estimated glomerular filtration rate (eGFR) that became significant by the end of the 2nd year of the study; renal function continued to deteriorate until the end of the study
The present study addressed whether or not the statininduced high-density lipoprotein cholesterol (HDL-C) increase contributed to renal function improvement on top of low-density lipoprotein cholesterol (LDL-C) reduction and other secondary CVD prevention measures
Summary
Chronic kidney disease (CKD), including mild renal impairment, is recognized as an independent predictor of cardiovascular disease (CVD) in high-risk patients [1,2,3]. The Physicians’ Health Study reported that from 4,483 participating healthy men with a normal baseline renal function, those with low high-density lipoprotein cholesterol (HDL-C) and high non-HDL-C [low-density lipoprotein cholesterol (LDL-C) + very LDL-C (VLDL-C) + intermediate density lipoprotein cholesterol (IDL-C)] levels had double the risk for CKD after adjusting for other risk factors [5]. Non-HDL-C levels were associated with an increased risk for deterioration of renal function in patients with CKD [6]. Little is known about the potential of statin-induced high-density lipoprotein cholesterol (HDL-C) increase to improve renal function in coronary heart disease (CHD) patients
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