Wieczorek-Surdacka Ewa, Świerszcz Jolanta, Surdacki Andrzej
Department of Nephrology, University Hospital, 31-501 Cracow, Poland.
Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, 31-501 Cracow, Poland.
Int J Mol Sci. 2016 Feb 2;17(2):106. doi: 10.3390/ijms17020106.
Angiotensin-converting enzyme inhibitors (ACEI) and statins are widely used in patients with coronary artery disease (CAD). Our aim was to compare changes in glomerular filtration rate (GFR) over time in subjects with stable CAD according to atorvastatin dose and concomitant use of ACEI. We studied 78 men with stable CAD referred for an elective coronary angiography who attained the then-current guideline-recommended target level of low-density lipoproteins (LDL) cholesterol below 2.5 mmol/L in a routine fasting lipid panel on admission and were receiving atorvastatin at a daily dose of 10-40 mg for ≥3 months preceding the index hospitalization. Due to an observational study design, atorvastatin dosage was not intentionally modified for other reasons. GFR was estimated during index hospitalization and at about one year after discharge from our center. Irrespective of ACEI use, a prevention of kidney function loss was observed only in those treated with the highest atorvastatin dose. In 38 subjects on ACEI, both of the higher atorvastatin doses were associated with increasing beneficial effects on GFR changes (mean ± SEM: -4.2 ± 2.4, 1.1 ± 1.6, 5.2 ± 2.4 mL/min per 1.73 m² for the 10-mg, 20-mg and 40-mg atorvastatin group, respectively, p = 0.02 by ANOVA; Spearman's rho = 0.50, p = 0.001 for trend). In sharp contrast, in 40 patients without ACEI, no significant trend effect was observed across increasing atorvastatin dosage (respective GFR changes: -1.3 ± 1.0, -4.7 ± 2.1, 4.8 ± 3.6 mL/min per 1.73 m², p = 0.02 by ANOVA; rho = 0.08, p = 0.6 for trend). The results were substantially unchanged after adjustment for baseline GFR or time-dependent variations of LDL cholesterol. Thus, concomitant ACEI use appears to facilitate the ability of increasing atorvastatin doses to beneficially modulate time-dependent changes in GFR in men with stable CAD.
血管紧张素转换酶抑制剂（ACEI）和他汀类药物广泛应用于冠状动脉疾病（CAD）患者。我们的目的是根据阿托伐他汀剂量和ACEI的联合使用情况，比较稳定型CAD患者肾小球滤过率（GFR）随时间的变化。我们研究了78名因择期冠状动脉造影而就诊的稳定型CAD男性患者，这些患者在入院时的常规空腹血脂检查中达到了当时指南推荐的低密度脂蛋白（LDL）胆固醇目标水平，即低于2.5 mmol/L，并且在本次住院前至少3个月每天接受10 - 40 mg阿托伐他汀治疗。由于采用观察性研究设计，阿托伐他汀剂量未因其他原因而有意调整。在本次住院期间以及从我们中心出院后约一年时估算GFR。无论是否使用ACEI，仅在接受最高阿托伐他汀剂量治疗的患者中观察到肾功能丧失得到预防。在38名使用ACEI的受试者中，两种较高剂量的阿托伐他汀均与GFR变化的有益作用增加相关（平均±标准误：阿托伐他汀10 mg组、20 mg组和40 mg组分别为-4.2±2.4、1.1±1.6、5.2±2.4 mL/min per 1.73 m²，方差分析p = 0.02；Spearman秩相关系数rho = 0.50，趋势p = 0.001）。形成鲜明对比的是，在40名未使用ACEI的患者中，随着阿托伐他汀剂量增加未观察到显著的趋势效应（各自的GFR变化：-1.3±1.0、-4.7±2.1、4.8±3.6 mL/min per 1.73 m²，方差分析p = 0.02；rho = 0.08，趋势p = 0.6）。在对基线GFR或LDL胆固醇的时间依赖性变化进行调整后，结果基本不变。因此，联合使用ACEI似乎有助于增加阿托伐他汀剂量对稳定型CAD男性患者GFR随时间变化进行有益调节的能力。
