Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
J Atheroscler Thromb. 2010 Mar 31;17(3):235-41. doi: 10.5551/jat.2683. Epub 2009 Dec 24.
Central pulse pressure and measures of arterial stiffness (augmentation index (AIx) and aortic pulse wave velocity (PWV)) predict morbidity and mortality in patients with stage 2-4 chronic kidney disease (CKD). Although statin therapy may be of vascular benefit in patients with CKD, the long-term effect of statins on central pulse pressure and arterial stiffness has not been assessed in this patient population. Hence, the aim of this study was to assess the long-term effects of atorvastatin on arterial stiffness and central blood pressure in patients with CKD.
We enrolled 37 patients with serum creatinine levels > 1.36 mg/dL into a randomized, double blind trial. Patients were allocated to receive 10 mg of atorvastatin per day (19) or placebo (18) for three years. Aortic PWV, AIx, estimated central and brachial blood pressures and were determined every nine months.
At baseline, there were no significant differences in aortic PWV, AIx, central or brachial blood pressures between atorvastatin-treated and placebo-treated patients. During the trial, aortic PWV significantly (p=0.05) increased in placebo-treated, but not (p=0.10) in atorvastatin-treated patients (0.51+/-0.95 vs. 0.30+/-0.75 m/sec/yr; p=0.48). This represented a 41% (but not statistically significant) slowing of the rate of increase in aortic stiffness. There were no significant changes between groups in the rate of change of AIx (atorvastatin -0.15+/-5.65 vs. placebo 0.39+/-5.38%/yr, p=0.53) or central pulse pressure (atorvastatin -2.32+/-7.46 vs. placebo -0.36+/-6.64 mmHg/yr p= 0.61).
In patients with CKD arterial stiffness measured by aortic PWV showed a significant increase over time in placebo-treated patients but not in atorvastatin-treated patients.
中心脉压和动脉僵硬度指标（增强指数（AIx）和主动脉脉搏波速度（PWV））可预测 2-4 期慢性肾脏病（CKD）患者的发病率和死亡率。虽然他汀类药物治疗可能对 CKD 患者有血管益处，但尚未在该患者人群中评估他汀类药物对中心脉压和动脉僵硬度的长期影响。因此，本研究旨在评估阿托伐他汀对 CKD 患者动脉僵硬度和中心血压的长期影响。
我们将 37 名血清肌酐水平>1.36mg/dL 的患者纳入一项随机、双盲试验。患者被分配每天接受 10mg 阿托伐他汀（19 名）或安慰剂（18 名）治疗三年。每九个月测定一次主动脉 PWV、AIx、估计的中心和肱动脉血压。
基线时，阿托伐他汀治疗组和安慰剂治疗组患者的主动脉 PWV、AIx、中心或肱动脉血压无显著差异。在试验过程中，安慰剂治疗组的主动脉 PWV 显著增加（p=0.05），而阿托伐他汀治疗组无显著变化（p=0.10）（0.51+/-0.95 与 0.30+/-0.75m/sec/yr；p=0.48）。这代表主动脉僵硬度增加率减慢了 41%（但无统计学意义）。两组间 AIx 变化率（阿托伐他汀-0.15+/-5.65 与安慰剂 0.39+/-5.38%/yr，p=0.53）或中心脉压变化率（阿托伐他汀-2.32+/-7.46 与安慰剂-0.36+/-6.64mmHg/yr，p=0.61）均无显著差异。
在 CKD 患者中，通过主动脉 PWV 测量的动脉僵硬度随时间推移在安慰剂治疗组患者中显著增加，但在阿托伐他汀治疗组患者中无显著增加。
