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Low cholesterol absorption may predict statin benefits in dialysis patients
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Measurement of intestinal cholesterol absorption may be a valuable tool for predicting the benefit of statin therapy in patients undergoing hemodialysis, researchers wrote in the Journal of the American College of Cardiology.
In a post-hoc analysis, researchers evaluated 1,030 participants in the German Diabetes and Dialysis (4D) study. All participants had type 2 diabetes, were aged 18 to 80 years and had been on maintenance hemodialysis therapy for less than 2 years.
Participants with available data on levels of cholestanol, a known biomarker of cholesterol absorption, were randomly assigned to a regimen of once-daily atorvastatin 20 mg (n = 519) or placebo (n = 511). Follow-up was conducted at 4 weeks and every 6 months after randomization.
The primary endpoint was a composite of death attributable to cardiac causes, stroke and nonfatal MI. The secondary endpoint included all-cause mortality and all cardiac events.
The researchers utilized tertiles of the cholestanol-to-cholesterol ratio to classify participants as high or low cholesterol absorbers.
In total, there were 454 occurrences of the primary endpoint. In multivariate analyses in which cholestanol-to-cholesterol ratios were stratified into tertiles, the researchers observed that atorvastatin decreased the risk for the primary endpoint in the first tertile (HR = 0.72; P = .049), but not the second (HR = 0.79; P = .225) or third (HR = 1.21; P = .287). Atorvastatin was associated with a steady, significant decrease in all-cause mortality and the risk for all cardiac events in the first tertile only, and was least beneficial for patients in the third tertile.
According to the researchers, these findings suggest that among patients on hemodialysis, those with lower rates of cholesterol absorption may derive benefit from atorvastatin treatment.
“We found that measurement of cholesterol absorption may help to identify hemodialysis patients who will benefit from treatment with statins,” the researchers wrote. “Beyond that, the data might argue in favor of a combination therapy that addresses both cholesterol synthesis and absorption to reduce CV risk in hemodialysis patients.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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