Pleiotropic effects of statins may improve outcomes in atherosclerotic renovascular disease.
BACKGROUND
Atherosclerotic renovascular disease (ARD) coexists with arterial obstructive disease in the coronary, cerebral, and peripheral arteries that may remain underdiagnosed and untreated.


METHODS
This retrospective study compares overall survival and renal survival (i.e., time to doubling of serum creatinine or end-stage renal disease (ESRD)) over an 11-year period in 104 ARD patients of whom 68 received statin therapy (group S) because of elevated lipid levels and 36 had no statin (group NS) because of normal lipid profile at entry.


RESULTS
Atherosclerosis in another vascular bed was documented in 84%. Lipid profiles at end point were virtually identical in both the groups. Group S had mean survival 123months (confidence interval (CI) 113-134) with four deaths, and mean renal survival 122months (CI 113-131). Group NS had mean survival 33 months (CI 23-42) with 13 deaths, and mean renal survival 27 months (CI 17-37).


CONCLUSIONS
Statin therapy was associated with lesser rate of progression of renal insufficiency (with 7.4% of S patients reaching renal end points vs. 38.9% of NS patients) and lower overall mortality (5.9 % in S vs. 36.1% in NS patients), P < 0.001 for both. Although both groups received what was deemed optimal therapy, they did have other differences that may have affected the outcomes (a limitation addressed by Cox multiple regression analysis). These results suggest the need for prospective randomized controlled studies in ARD patients in order to explore potential benefits of statins that may not be attributable solely to lipid lowering.
Silva
Vanessa S
VS
Division of Nephrology, Department of Internal Medicine, Botucatu Medical School, São Paulo State University, São Paulo, Brazil.
Martin
Luis C
LC
Franco
Roberto J S
RJ
Carvalho
Fabio C
FC
Bregagnollo
Edson A
EA
Castro
Joao H
JH
Gavras
Irene
I
Gavras
Haralambos
H
D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D001794:Blood Pressure / Q000187:drug effects; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D012078:Renal Artery Obstruction / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors