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Published on: November 10, 2017

Pravastatin and cardiovascular outcomes stratified by baseline eGFR in the lipid- lowering component of ALLHAT

Mahboob Rahman, Charles Baimbridge, Barry R Davis

    Clinical Nephrology
    |July 3, 2013
    PubMed

    Insights

    Pravastatin did not outperform usual care for preventing cardiovascular events in patients with chronic kidney disease (CKD). However, adherence to statin therapy and cholesterol reduction showed potential benefits in reducing mortality and coronary heart disease (CHD) risk.

    Area of Science:

    • Nephrology
    • Cardiology
    • Pharmacology

    Background:

    • The efficacy of statins in preventing cardiovascular outcomes in patients with chronic kidney disease (CKD) remains uncertain.
    • This study investigates cardiovascular outcomes associated with pravastatin compared to usual care, stratified by baseline estimated glomerular filtration rate (eGFR).

    Purpose of the Study:

    • To compare cardiovascular outcomes between pravastatin and usual care in patients with CKD.
    • To assess the impact of baseline eGFR on the effectiveness of pravastatin therapy.

    Main Methods:

    • Post-hoc analysis of a prospective randomized clinical trial involving 10,151 participants from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.
    • Participants were randomized to pravastatin 40 mg/day or usual care, with a mean follow-up of 4.8 years.

    Main Results:

    • Intention-to-treat analyses showed no significant differences in coronary heart disease (CHD), total mortality, or combined cardiovascular disease between pravastatin and usual care groups, irrespective of eGFR strata.
    • Exploratory "as-treated" analyses indicated that pravastatin use was associated with reduced mortality and CHD.
    • A 10 mg/dl reduction in total cholesterol from baseline was linked to a 5% decrease in CHD risk.

    Conclusions:

    • Pravastatin was not superior to usual care in preventing total mortality or CHD in hypertensive patients with moderate dyslipidemia, regardless of baseline eGFR.
    • Exploratory analyses suggest that pravastatin use may improve mortality and CHD risk.
    • The potential benefits of statin therapy may be linked to the degree of total and LDL-cholesterol reduction achieved and patient adherence.
    Abstract

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