Effects of HMG-CoA Reductase Inhibitors on Cardiovascular Events and Renal Function in Patients with Chronic Kidney Disease

• Main Authors: Chieh-Ying Chen, 陳潔瑩
• Other Authors: Shang-Jyh Hwang
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/29967318275485345655

碩士 === 高雄醫學大學 === 臨床藥學研究所 === 101 === Background: In Taiwan, the prevalence of chronic kidney disease (CKD) among adult is 12%. CKD is one of the risk factors of cardiovascular disease (CVD). HMG-CoA reductase inhibitors (statin) is the first-line agent for treatment of hypercholesterolemia. There are evidences that statin improve the CVD morbidity and mortality in mild-to-moderate CKD patients. However, the efficacy and safety of statin in severe CKD population is still unsure. Recently, there are some studies that assessed the effect of statin on renal function but the influence of statin on renal function is controversial. Aim and objectives: The study aimed to explore the effect of statin on CVD and adverse reaction in dialysis population by systematic review and meta-analysis. Otherwise, the study also used hospital-based database to investigate the medical utilization of statin in CKD patients, the factors related to CVD and renal function. Methods: This study divided into two parts. The first part was systematic review and meta-analysis. It explored the effects of statin comparing with placebo or no treatment on CVD, cerebrovascular disease, cardiovascular mortality, all-cause mortality and lipid profiles in dialysis patients among randomized controlled trials (RCTs) and observational studies. This study also examined the safety of statin using in dialysis population. The other part was the hospital-based retrospectively cohort study. We included CKD patients who using statin between January 2006 and December 2006. We followed from the date of first prescription for a statin to the end of the study (December 31, 2012), death or loss to follow-up. We recorded all patients’ baseline characteristics and study-related medical record to evaluate prescribing pattern of statin, the factors associated with CVD and renal function and safety. Results: The systematic review and meta-analysis identified a total of 23 RCTs with 8299 participants and 6 cohort studies with 13849 patients. The result of SR and MA showed that statin significantly decrease the CVD rate (HR 0.92, 95% CI 0.85, 0.98), cardiovascular mortality (HR 0.83, 95% CI 0.71, 0.98) and all-cause mortality (HR 0.78, 95% CI 0.66, 0.91) but there was no statistically significant difference on cerebrovascular disease between the two groups. Stains significantly decrease total cholesterol, low density lipoprotein, triglyceride and increase high density lipoprotein. There was similar occurrence of all safety outcomes with statin in comparison to placebo. In the hospital-based cohort study, there were 101 patients with mean follow-up period of 5.3 years were included. The mean prescription possession ratio (MPR) of statin was 43%. Coronary artery disease (CAD) history was associated with increasing the risk of atherosclerotic events, but use of angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor was related to decreasing cardiovascular risk. Patient’s baseline estimated glomerular filtration rate (eGFR) was associated with renal progression to end-stage renal disease, and high MPR of statin was related to enhancing the decrease of eGFR. Conclusion: The systematic review and meta-analysis showed that statin significantly reduced the CVD rate, cardiovascular mortality and all-cause mortality in dialysis population. Statin appeared to be safe in dialysis population. The retrospective cohort study found CAD was associated with increasing CVD risk in CKD patients using statin. Patients’ baseline eGFR and MPR of statin were related to renal progression.