Abstract 11909: The Anti-atherosclerotic Effect of Statin is Augmented In Patients With Impaired Renal Function: A Sub-analysis of The PEACE Study

Abstract

Background: Renal dysfunction is a significant risk factor for the cardiovascular disease. Although beneficial effects of statin on the prevention of cardiovascular events have been established, little is known about the impact of renal function on the anti-atherosclerotic effect of statin. Therefore, we evaluated the influence of renal function assessed by the estimated glomerular filtration rate (eGFR) on the anti-atherosclerotic effect of statin using the data from the PEACE study.

Methods: The PEACE study is a multicenter, prospective, randomized, open-labeled, blinded endpoints, two-arm parallel treatment group comparison study. Japanese patients with carotid intima-media thickness (CIMT) thickening whose LDL-C level was more than 100 mg/dl (303 patients, 42.6% female, mean 66.3 years) were randomized to receive either moderate (target LDL-C; 100mg/dl) or intensive (target LDL-C; 80mg/dl) cholesterol-lowering therapy with pitavastatin. The primary endpoint is the change in mean CIMT over 1 year. In this sub-analysis, patients were divided into 2 groups of which eGFR was either lower (mean 58.80) or higher (mean 86.41) than the median value (71.47).

Result: The LDL-C levels at baseline (low eGFR group; 143.1mg/dl, and high eGFR group; 143.9mg/dl) and at 1-year follow-up (low eGFR group; 91.3mg/dl, and high eGFR group; 93.9mg/dl) were similar between the 2 groups. Also, the baseline CIMT was not different between the groups. Interestingly, the mean CIMT was significantly regressed during the 1-year treatment in the low eGFR group (-2.9%/year, P=0.0085 vs. baseline), but not in the high eGFR group (0.29%/year, P=0.80 vs. baseline) [P=0.042 between the groups]. Of note, pitavastatin treatment significantly increased the eGFR at 1-year follow-up (2.4±13.8% increase; P=0.012 vs. baseline) independently of the LDL-C-lowering effect. When focused on patients with chronic kidney disease (eGFR<60), the improvement of eGFR was significantly associated with the regression in mean CIMT.

Conclusions: Pitavastatin increased the eGFR in patients with sub-clinical carotid atherosclerosis, and its anti-atherosclerotic effect was more evident in patients with low eGFR than in patients with high eGFR.