title: Atorvastatin and low-density lipoprotein cholesterol in type 2 diabetes mellitus patients on hemodialysis.
abstract: OBJECTIVE
  Patients undergoing maintenance hemodialysis are at high cardiovascular risk. Lowering LDL-cholesterol with statins reduces the incidence rate of cardiovascular events in patients with chronic kidney disease. In contrast, two randomized, prospective, placebo-controlled trials have been completed in hemodialysis patients that showed no significant effects of statins on cardiovascular outcomes.
  
  
  METHODS
  A post hoc analysis was conducted of the 4D (Die Deutsche Diabetes Dialyze) study to investigate whether LDL-cholesterol at baseline is predictive of cardiovascular events and whether the effect of atorvastatin on clinical outcomes depends on LDL-cholesterol at baseline.
  
  
  RESULTS
  High concentrations of LDL-cholesterol by tendency increased the risks of cardiac endpoints and all-cause mortality. Concordantly, atorvastatin significantly reduced the rates of adverse outcomes in the highest quartile of LDL-cholesterol (≥145 mg/dl, 3.76 mmol/L). The hazard ratios and 95% confidence intervals were 0.69 (0.48 to 1.00) for the composite primary endpoint, 0.58 (0.34 to 0.99) for cardiac death, 0.48 (0.25 to 0.94) for sudden cardiac death, 0.62 (0.33 to 1.17) for nonfatal myocardial infarction, 0.68 (0.47 to 0.98) for all cardiac events combined, and 0.72 (0.52 to 0.99) for death from all causes, respectively. No such decrease was seen in any of the other quartiles of LDL-cholesterol at baseline.
  
  
  CONCLUSIONS
  In patients with type 2 diabetes mellitus undergoing hemodialysis, atorvastatin significantly reduces the risk of fatal and nonfatal cardiac events and death from any cause if pretreatment LDL-cholesterol is >145 mg/dl (3.76 mmol/L).
authors.affiliation: Synlab Center of Laboratory Diagnostics Heidelberg, Heidelberg, Germany. winfried.maerz@synlab.com
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.forename: Bernd
authors.initials: B
authors.lastname: Genser
authors.forename: Christiane
authors.initials: C
authors.lastname: Drechsler
authors.forename: Vera
authors.initials: V
authors.lastname: Krane
authors.forename: Tanja B
authors.initials: TB
authors.lastname: Grammer
authors.forename: Eberhard
authors.initials: E
authors.lastname: Ritz
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.forename: Hubert
authors.initials: H
authors.lastname: Scharnagl
authors.forename: Karl
authors.initials: K
authors.lastname: Winkler
authors.forename: Ingar
authors.initials: I
authors.lastname: Holme
authors.forename: Hallvard
authors.initials: H
authors.lastname: Holdaas
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004311:Double-Blind Method; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005858:Germany; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin