Abstract 3731: Marked Reduction in Cardiovascular Events with Pravastatin in Hypercholesterolemic Patients with Mild or Moderate Chronic Kidney Disease
Background: Chronic kidney disease (CKD) has been identified as a potent risk factor for cardiovascular disease. In persons with CKD, a reduction in the incidence of cardiovascular events was observed in three large-scale secondary intervention trials with pravastatin. This analysis sought to confirm the cardiovascular benefit of pravastatin in hypercholesterolemic patients with mild or moderate CKD in the Japanese primary prevention MEGA Study.
Methods: This post-hoc analysis of the MEGA Study population examined 7,212 of the 7,832 hypercholesterolemic patients (620 patients excluded because their serum creatinine (Scr) levels were not determined). The estimated glomerular filtration rate (eGFR) was determined using the Modified Diet and Renal Disease Trial formula [186 × (Scr + 0.2)−1.154 × Age−0.203 × 0.881 (×0.746 in women); Scr was adjusted when it was determined using the enzymatic method]. Patients were classified as having normal or mild CKD (≥60 mL/min per 1.73 m2) and moderate CKD (30<, <60 mL/min per 1.73 m2).
Results: The baseline anthropometric and lipid data were not significantly different between diet alone group (n=3672) and diet + Pravastatin (10–20 mg/day) group (n=3540). Regarding baseline renal function, eGFR was 64.19±13.27 mL/min per 1.73 m2 and 64.31±13.41 mL/min per 1.73 m2 respectively (p=0.5614). An increase in coronary heart disease (CHD) was found in the moderate CKD group (n=1507) compared to normal/mild CKD group (n=2156), with a hazard ratio (HR) of 1.487 (p=0.0831) in the diet alone group at five years. Stroke was increased by 35% (p=0.27), CHD+ischemic stroke by 46% (p=0.0447), and total cardiovascular events by 37% (p=0.063). Pravastatin reduced CHD events by 48% (p=0.0164), stroke by 73% (p=0.0012), ischemic stroke by 82% (p=0.0016), CHD+ischemic stroke by 59% (p=0.0002), and total mortality by 52% (p=0.0163) in the moderate CKD group.
Conclusion: Cardiovascular events were increased in the moderate CKD group and pravastatin significantly reduced cardiovascular event rates in this group.