Department of Medicine, Chicago Medical School, IL 60064, USA.
Am J Ther. 2011 May;18(3):e48-54. doi: 10.1097/MJT.0b013e3181cec203.
Patients with chronic kidney disease including renal transplant recipients (RTRs) have a markedly higher prevalence of cardiovascular disease than the general population. Many trials have established the role of statins in the prevention of cardiovascular mortality, not only by decreasing the low density lipoprotein-cholesterol levels but also by their pleotropic effects. These data from the general population may not be applicable to RTRs as these patients have different cardiovascular risk profiles. Till date, only a few prospective, randomized trials have assessed the use of statins in RTRs with regards to cardiovascular outcomes. The Assessment of Lescol in Renal Transplant trial, the largest trial so far, suggested that dyslipidemia management with statins in RTRs is associated with a significant reduction in the incidence of cardiac death and nonfatal myocardial infarction (although differences in the combined primary end point were not statistically significant). The current guidelines from National Kidney Foundation for managing dyslipidemia in RTRs recommend managing all chronic kidney disease patients as a coronary heart disease equivalent. The task group for drafting these guidelines concluded that based on the currently available evidence, additional studies may be needed in RTRs to confirm and extend the results of Assessment of Lescol in Renal Transplant trial.
患有慢性肾脏疾病的患者，包括肾移植受者（RTR），其心血管疾病的患病率明显高于普通人群。许多试验已经证实了他汀类药物在预防心血管死亡率方面的作用，不仅通过降低低密度脂蛋白胆固醇水平，而且通过其多效性作用。这些来自普通人群的数据可能不适用于 RTR，因为这些患者具有不同的心血管风险特征。迄今为止，只有少数前瞻性、随机试验评估了他汀类药物在 RTR 中用于心血管结局的情况。迄今为止最大的试验——Lescol 在肾移植中的评估试验表明，他汀类药物治疗 RTR 的血脂异常与心脏死亡和非致死性心肌梗死的发生率显著降低相关（尽管联合主要终点的差异没有统计学意义）。美国国家肾脏基金会管理 RTR 血脂异常的现行指南建议将所有慢性肾脏病患者作为冠心病等同对待。制定这些指南的专家组得出结论，基于目前可用的证据，可能需要在 RTR 中进行更多的研究，以确认和扩展 Lescol 在肾移植中的评估试验的结果。
