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Rosuvastatin reduced risk for first CV events, all-cause death in patients with moderate chronic kidney disease

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Rosuvastatin therapy was associated with a reduction in first CV events and all-cause mortality in patients with concomitant evidence of moderate chronic kidney disease, elevated high-sensitivity C-reactive protein and LDL <130 mg/dL.

U.S. researchers conducting a secondary analysis of results from the JUPITER study examined a subset of enrolled patients who presented with moderate CKD at study entry (n=3,267) and compared them with patients whose estimated glomerular filtration rate was ≥60 mL per minute per 1.73 m² (n=14,528). Patients in the JUPITER study were randomly assigned to either rosuvastatin 20 mg daily (Crestor, AstraZeneca) or placebo. Patients were followed for a median of 1.9 years.

The researchers reported that patients with moderate CKD had higher vascular event rates than those with an eGFR ≥60 mL per minute per 1.73 m² (HR=1.54; 95% CI, 1.23-1.92). Rosuvastatin was associated with a 45% reduction in the risk for MI, stroke, hospital stay for unstable angina, revascularization or confirmed CV death (HR=0.55; 95% CI, 0.38-0.82) and a 44% reduction in all-cause mortality (HR=0.56; 95% CI, 0.37-0.85) in patients with moderate CKD.

Rosuvastatin was also associated with a 52% reduction in LDL and a 37% mean reduction in high-sensitivity CRP from baseline among patients with moderate CKD (P<.001 for both values). Median reductions in LDL and high-sensitivity CRP levels were similar in patients without moderate CKD. Moderate improvement in eGFRs at one year among patients assigned to rosuvastatin vs. placebo (P=.02) was also reported.

“These data support guidelines from the American Heart Association and the National Kidney Foundation to provide more aggressive CV prevention efforts among those with mild to moderately reduced renal function,” the researchers wrote. – by Eric Raible

Ridker PM. J Am Coll Cardiol. 2010;doi:10.1016/j.jacc.2010.01.020.

This post hoc analysis of the JUPITER trial, evaluating the effects of rosuvastatin in people with Stage 3 nephropathy (eGFR <60 mL per minute) and elevated high-sensitivity CRP, demonstrates clear benefit on CV outcomes in this group. This is not surprising since this group is at much higher CV risk than the general population.

The authors correctly point out that the two published trials of statin use in dialysis patients are not indicative of patients with earlier stage chronic kidney disease. No statement can be made about nephropathy progression since patients were not evaluated for albuminuria and the duration of follow-up was too short given the baseline GFR. Nevertheless, the point made is critical – people with Stage 3 chronic kidney disease (eGFR <60 mL per minute) clearly garner a CV benefit by having their cholesterol controlled.

– George L. Bakris, MD
Cardiology Today Editorial Board

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