Abstract 4840: Are Statins Nephroprotective? A PCI Study to Explore for Possible Pleiotropism
HMG-CoA reductase inhibitors (statins) are used for dyslipidemia treatment and CAD prevention. Considerable controversy exists regarding statins’ possible pleiotropic effect with many vascular and nonvascular beds benefiting from their use. However, little data exists to support possible nephroprotective statins effect or their potential for ‘nephro-pleiotropism’.
Hypothesis We hypothesize that pre-administration of statins in patients prior to undergoing percutaneous coronary intervention (PCI) may be beneficial in preventing contrast induced nephropathy (CIN) due to a pleiotropic effect.
Methods A retrospective study of >4000 patient charts who underwent PCI for routine clinical reasons was performed. Pts who developed CIN were selected based on serum creatinine (SCr) level elevation by ≥0.5mg/dL from baseline and further stratified into statin use (+/−) prior to PCI and by LDL level.
Results SCr was measured within 1 week prior to or on day of PCI in 805 pts: 516 (64%) male, 289 (36%) female and within 1 week post PCI. Statin therapy was initiated in 328 (41%) pts ≥1 week prior to PCI. When classified by statin use (+/−), there was no difference in incidence of CIN (29 vs 39, p=0.8). However, there was a significant number of pts with SCr rise to >2.5mg/dL in the statin(−) group (p<0.05). When limited to absolute rise in SCr, the mean rise in SCr was 0.64 in statin(−) vs 0.16mg/dL in statin(+) subgroup, representing a 3-fold nephroprotective effect of statins (p<0.001). Via multivariate analysis, neither age, gender, HTN, DM or contrast load was a significant predictor for the rise in SCr. In 44 pts (16 statin(+), 28 statin(−)) with recent LDL levels there was no difference in the mean LDL (99 vs 91mg/dL respectively, p=NS) and this pattern held true when categorized by LDL <70, <100, or <130mg/dL (p=NS for all), again independent of all defined comorbidities.
Conclusions Pre-PCI administration of statins is strongly nephroprotective. Multivariate analysis demonstrates the 3-fold nephroprotection is independent of common clinical high risk comorbidities. A more controversial finding implicates the lack of a direct anti-atherosclerotic LDL lowering effect as the genesis since LDL levels were nearly superimposable, implying substantial pleiotropism.