title: Long-term fluvastatin reduces the hazardous effect of renal impairment on four-year atherosclerotic outcomes (a LIPS substudy).
abstract: Mild renal impairment is an important risk factor for late cardiovascular complications. This substudy of the Lescol Intervention Prevention Study (LIPS) assessed the effect of fluvastatin on outcome of patients who had renal dysfunction and those who did not. Complete data for creatinine clearance calculation (Cockcroft-Gault formula) were available for 1,558 patients (92.9% of the LIPS population). Patients were randomized to fluvastatin or placebo after successful completion of a first percutaneous coronary intervention. Follow-up time was 3 to 4 years. The effect of baseline creatinine clearance on coronary atherosclerotic events (cardiac death, nonfatal myocardial infarction, and coronary reinterventions not related to restenosis) was evaluated. Baseline creatinine clearance (logarithmic transformation) was inversely associated with an incidence of adverse events among patients who received placebo (hazard ratio 0.99, 95% confidence interval 0.982 to 0.998, p = 0.01). However, no association was noted between creatinine clearance and the incidence of adverse events among patients who received fluvastatin (hazard ratio 1.0, 95% confidence interval 0.99 to 1.0, p = 0.63). No further deterioration in creatinine clearance was observed during follow-up, regardless of baseline renal function or allocated treatment. Occurrence of adverse events was not related to changes in renal function during follow-up. Fluvastatin therapy markedly decreased the risk of coronary atherosclerotic events after percutaneous intervention in patients who had lower values of creatinine clearance at baseline. The benefit of fluvastatin was unrelated to any effect on renal function.
authors.affiliation: Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Pim
authors.initials: P
authors.lastname: de Feyter
authors.forename: Nestor F
authors.initials: NF
authors.lastname: Mercado
authors.forename: Dick
authors.initials: D
authors.lastname: Goedhart
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Chourmouzios A
authors.initials: CA
authors.lastname: Arampatzis
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Soares
authors.forename: Marco
authors.initials: M
authors.lastname: Ciccone
authors.forename: Massimo
authors.initials: M
authors.lastname: Arquati
authors.forename: Michele
authors.initials: M
authors.lastname: Cortellaro
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rutsch
authors.forename: Victor
authors.initials: V
authors.lastname: Legrand
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy; D003404:Creatinine / Q000097:blood; D005060:Europe / Q000453:epidemiology; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use*; D005260:Female; D000077340:Fluvastatin; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007211:Indoles / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000097:blood / Q000517:prevention & control*; D008074:Lipoproteins / Q000097:blood / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D005229:Fatty Acids, Monounsaturated; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007211:Indoles; D008074:Lipoproteins; D000077340:Fluvastatin; D003404:Creatinine