Department of Medicine, Divisions of Cardiology, William Beaumont Hospital, 4949 Coolidge, Royal Oak, MI 48073, USA.
J Clin Lipidol. 2008 Oct;2(5):318-27. doi: 10.1016/j.jacl.2008.06.008. Epub 2008 Jun 26.
Chronic kidney disease (CKD) creates one of the highest risk atherosclerotic states that can occur in human beings. The use of 3-hydroxy-3-methylglutaryl coenzyme reductase inhibitors (statins) has gained widespread acceptance in the general population for the purposes of lowering low-density lipoprotein cholesterol (LDL-C) and reducing the future risks of myocardial infarction, stroke, and cardiac death. In patients with CKD, the balance of benefits and risks of statins appears to be different than that in the general population. Reductions in LDL-C with statins may be associated with a reduced progression of CKD. Importantly, recent studies suggest statins are associated with a reduction in rates of acute kidney injury, mediated by ischemic insults and oxidative stress, after cardiac surgery and exposure to iodinated contrast. A reduction in cardiovascular events with LDL-C reduction in CKD and dialysis patients is yet to be proven. In addition, studies suggest that there are higher adverse drug effects with statins in CKD. This work will address the benefits and risks of this important treatment option for the growing population of patients with CKD, who have not undergone renal transplantation, and are at very high risk of cardiovascular events.
慢性肾脏病 (CKD) 可导致人类发生极高风险的动脉粥样硬化状态之一。3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）已被广泛用于降低低密度脂蛋白胆固醇 (LDL-C) 和降低心肌梗死、中风和心脏死亡的未来风险。在 CKD 患者中，他汀类药物的获益和风险平衡似乎与普通人群不同。他汀类药物降低 LDL-C 可能与 CKD 进展减缓有关。重要的是，最近的研究表明，他汀类药物可通过心脏手术后的缺血性损伤和氧化应激，以及碘造影剂暴露，降低急性肾损伤的发生率。在 CKD 和透析患者中，通过 LDL-C 降低来减少心血管事件的效果尚未得到证实。此外，研究表明，他汀类药物在 CKD 患者中具有更高的药物不良反应。本研究将探讨这一重要治疗方案在未接受肾移植且心血管事件风险极高的 CKD 患者中的获益和风险。
