Toyama Kensuke, Sugiyama Seigo, Oka Hideki, Iwasaki Yuri, Sumida Hitoshi, Tanaka Tomoko, Tayama Shinji, Jinnouchi Hideaki, Ogawa Hisao
Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Division of Cardiology, Health Insurance Hitoyoshi General Hospital, Kumamoto, Japan.
Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Diabetes Care Center, Jinnouchi Hospital, Kumamoto, Japan.
J Cardiol. 2014 Aug;64(2):91-7. doi: 10.1016/j.jjcc.2013.11.018. Epub 2014 Jan 20.
Statins and exercise therapy are clinically effective in preventing cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to determine the effects of statins combined with exercise on the renal function of CAD patients.
We performed a sub-analysis of a clinical trial that determined the 20-week-effects of two statins (rosuvastatin, n=14; atorvastatin, n=14) combined with regular exercise on renal function, as assessed by the estimated glomerular filtration rates (eGFRs) of CAD patients.
The combination of statins and exercise therapy increased eGFRs from 61.1±16.6 at baseline to 65.8±16.8ml/min/per 1.73m(2) (p=0.03), increased serum levels of high-molecular-weight (HMW) adiponectin, increased ubiquinol/low-density lipoprotein cholesterol (LDL-C) ratios, and decreased high sensitivity C-reactive protein (hs-CRP). Changes in HMW-adiponectin, ubiquinol/LDL-C ratios and hs-CRP were significantly correlated with changes in eGFR (r=0.597, p=0.001; r=0.437, p=0.02; and r=-0.473, p=0.01, respectively). Treatment-induced increases in HMW-adiponectin independently correlated with the increases in eGFR (β=0.513, p=0.02) in a multivariate analysis. Both atorvastatin and rosuvastatin combined with regular exercise produced increases in eGFR. The patients treated with rosuvastatin exhibited significant improvements in eGFR.
Statins combined with exercise significantly increased eGFR in CAD patients, and these improvements in renal function were correlated with increases in HMW-adiponectin levels. The statins-exercise combination treatment may have provided clinical benefits for patients with CAD partly through the improvement in renal function.
他汀类药物和运动疗法在预防冠状动脉疾病(CAD)患者心血管事件方面具有临床疗效。本研究旨在确定他汀类药物联合运动对CAD患者肾功能的影响。
我们对一项临床试验进行了亚分析,该试验确定了两种他汀类药物(瑞舒伐他汀,n = 14;阿托伐他汀,n = 14)联合规律运动对CAD患者肾功能的20周影响,通过估算肾小球滤过率(eGFR)进行评估。
他汀类药物与运动疗法联合使用使eGFR从基线时的61.1±16.6升高至65.8±16.8ml/min/每1.73m²(p = 0.03),血清高分子量(HMW)脂联素水平升高,泛醇/低密度脂蛋白胆固醇(LDL-C)比值升高,高敏C反应蛋白(hs-CRP)降低。HMW-脂联素、泛醇/LDL-C比值和hs-CRP的变化与eGFR的变化显著相关(分别为r = 0.597,p = 0.001;r = 0.437,p = 0.02;r = -0.473,p = 0.01)。在多变量分析中,治疗引起的HMW-脂联素增加与eGFR的增加独立相关(β = 0.513,p = 0.02)。阿托伐他汀和瑞舒伐他汀联合规律运动均使eGFR升高。接受瑞舒伐他汀治疗的患者eGFR有显著改善。
他汀类药物联合运动显著提高了CAD患者的eGFR,这些肾功能的改善与HMW-脂联素水平的升高相关。他汀类药物与运动的联合治疗可能部分通过改善肾功能为CAD患者带来临床益处。