Tonelli Marcello, Isles Chris, Curhan Gary C, Tonkin Andrew, Pfeffer Marc A, Shepherd James, Sacks Frank M, Furberg Curt, Cobbe Stuart M, Simes John, Craven Timothy, West Malcolm
Division of Nephrology, University of Alberta, 7-129 Clinical Science Building, 8440 112 St, Edmonton, Alberta T6G 2G3, Canada.
Circulation. 2004 Sep 21;110(12):1557-63. doi: 10.1161/01.CIR.0000143892.84582.60. Epub 2004 Sep 13.
Limited data describe the cardiovascular benefit of HMG-CoA reductase inhibitors (statins) in people with moderate chronic kidney disease (CKD). The objective of this analysis was to determine whether pravastatin reduced the incidence of cardiovascular events in people with or at high risk for coronary disease and with concomitant moderate CKD.
We analyzed data from the Pravastatin Pooling Project (PPP), a subject-level database combining results from 3 randomized trials of pravastatin (40 mg daily) versus placebo. Of 19 700 subjects, 4491 (22.8%) had moderate CKD, defined by an estimated glomerular filtration rate of 30 to 59.99 mL/min per 1.73 m2 body surface area. The primary outcome was time to myocardial infarction, coronary death, or percutaneous/surgical coronary revascularization. Moderate CKD was independently associated with an increased risk of the primary outcome (adjusted HR 1.26, 95% CI 1.07 to 1.49) compared with those with normal renal function. Among the 4491 subjects with moderate CKD, pravastatin significantly reduced the incidence of the primary outcome (HR 0.77, 95% CI 0.68 to 0.86), similar to the effect of pravastatin on the primary outcome in subjects with normal kidney function (HR 0.78, 95% CI 0.65 to 0.94). Pravastatin also appeared to reduce the total mortality rate in those with moderate CKD (adjusted HR 0.86, 95% CI 0.74 to 1.00, P=0.045).
Pravastatin reduces cardiovascular event rates in people with or at risk for coronary disease and concomitant moderate CKD, many of whom have serum creatinine levels within the normal range. Given the high risk associated with CKD, the absolute benefit that resulted from use of pravastatin was greater than in those with normal renal function.
关于羟甲基戊二酸单酰辅酶A还原酶抑制剂（他汀类药物）对中度慢性肾脏病（CKD）患者心血管益处的数据有限。本分析的目的是确定普伐他汀是否能降低冠心病患者或冠心病高危且合并中度CKD患者的心血管事件发生率。
我们分析了普伐他汀汇总项目（PPP）的数据，该项目是一个受试者水平的数据库，汇总了3项普伐他汀（每日40毫克）与安慰剂对比的随机试验结果。在19700名受试者中，4491名（22.8%）患有中度CKD，定义为估算肾小球滤过率为每1.73平方米体表面积30至59.99毫升/分钟。主要结局为首次发生心肌梗死、冠状动脉死亡或经皮/外科冠状动脉血运重建的时间。与肾功能正常者相比，中度CKD与主要结局风险增加独立相关（校正风险比1.26，95%置信区间1.07至1.49）。在4491名中度CKD受试者中，普伐他汀显著降低了主要结局的发生率（风险比0.77，95%置信区间0.68至0.86），与普伐他汀对肾功能正常受试者主要结局的影响相似（风险比0.78，95%置信区间0.65至0.94）。普伐他汀似乎还降低了中度CKD患者的总死亡率（校正风险比0.86，95%置信区间0.74至1.00，P=0.045）。
普伐他汀可降低冠心病患者或冠心病高危且合并中度CKD患者的心血管事件发生率，其中许多患者的血清肌酐水平在正常范围内。鉴于CKD相关的高风险，使用普伐他汀带来的绝对益处大于肾功能正常者。
