Simvastatin for secondary prevention of all-cause mortality and major coronary events in patients with mild chronic renal insufficiency.
BACKGROUND
A potentially modifiable risk factor for cardiovascular disease in patients with mild chronic renal insufficiency is dyslipidemia. Few studies examined the effects of statins on all-cause mortality and major coronary events in patients with renal dysfunction.


METHODS
We performed a post hoc analysis from the Randomized Trial of Cholesterol Lowering in 4,444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study. Of 4,444 participants, 2,314 (52.1%) had mild chronic renal insufficiency defined as an estimated glomerular filtration rate less than 75 mL/min/1.73 m(2) (<1.25 mL/s), measured using the Modification of Diet in Renal Disease equation. The primary end point was all-cause mortality.


RESULTS
During the follow-up period, simvastatin use was associated with decreased all-cause mortality (adjusted hazard ratio [HR], 0.69; confidence interval [CI], 0.54 to 0.89) in the 2,314 participants with mild chronic renal insufficiency. Rates of major coronary events (adjusted HR, 0.67; CI, 0.56 to 0.79) and coronary revascularization (adjusted HR, 0.62; CI, 0.49 to 0.77) also were significantly lower in the simvastatin group. No significant decreases in stroke incidence were observed in the simvastatin group (adjusted HR, 0.88; CI, 0.55 to 1.39). The side-effect profile was similar between the 2 treatment groups.


CONCLUSIONS
Simvastatin therapy appears to be effective and safe for the secondary prevention of all-cause mortality and major coronary events in patients with mild chronic renal dysfunction.
Chonchol
Michel
M
Division of Renal Diseases and Hypertension, University of Colorado Health Sciences Center, Denver, CO 80262, USA. michel.chonchol@uchsc.edu
Cook
Thomas
T
Kjekshus
John
J
Pedersen
Terje R
TR
Lindenfeld
JoAnn
J
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D004311:Double-Blind Method; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries; D019821:Simvastatin / Q000009:adverse effects / Q000627:therapeutic use*
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin