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Effects of atorvastatin treatment on left ventricular diastolic function in peritoneal dialysis patients-The ALEVENT
Cho-Kai Wu1, Chih-Fan Yeh1, Jiun-Yang Chiang1
1Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Insights
Atorvastatin improved cardiac diastolic function in peritoneal dialysis patients with elevated C-reactive protein. This study shows statin benefits for heart health in PD patients, even without hyperlipidemia.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Left ventricular diastolic dysfunction (LVDD) is prevalent in peritoneal dialysis (PD) patients.
- Elevated inflammatory biomarkers, like high-sensitivity C-reactive protein (hs-CRP), predict LVDD development in PD patients.
Purpose of the Study:
- To investigate the efficacy of atorvastatin in improving LVDD in PD patients with elevated hs-CRP levels.
- To test the hypothesis that statin therapy benefits PD patients with LVDD and inflammation.
Main Methods:
- A randomized clinical trial involving 213 PD patients, with 32 participants assigned to atorvastatin (40 mg daily) or a control group.
- Inclusion criteria: hs-CRP ≥1.5 mg/L, low-density lipoprotein cholesterol <130 mg/dL, and LVDD diagnosed by echocardiography.
- Primary endpoints: changes in tissue Doppler imaging (TDI) diastolic parameters and global strain imaging diastolic parameters.
Main Results:
- Atorvastatin significantly reduced hs-CRP levels by 45% (P < .001) and LDL cholesterol by 43% (P < .001).
- Significant improvements were observed in TDI parameters (E/Emedial, P = .02) and global strain imaging (global strain rate, P = .002; E/SRIVR, P = .003) in the atorvastatin group.
- These findings indicate enhanced cardiac diastolic function following atorvastatin treatment.
Conclusions:
- Atorvastatin significantly improved cardiac diastolic function in PD patients with elevated hs-CRP and LVDD, even in the absence of hyperlipidemia.
- The study supports the use of statins to manage LVDD in specific PD patient populations.
- ClinicalTrials.gov identifier: NCT01503671.
Background:
Left ventricular diastolic dysfunction (LVDD) is common among patients undergoing peritoneal dialysis (PD). Increased levels of inflammatory biomarkers, such as high-sensitivity C-reactive protein, predict the development of LVDD.
Objectives:
We hypothesized that PD patients with elevated high-sensitivity C-reactive protein levels might benefit from statin treatment for LVDD and designed a randomized clinical trial to prove the hypothesis.
Methods:
We screened 213 PD patients and randomly assigned 32 men and women with low-density lipoprotein cholesterol levels <130 mg/dL, high-sensitivity C-reactive protein levels of ≥1.5 mg/L, and LVDD, diagnosed by conventional and tissue Doppler imaging (TDI) echocardiography, to treatment with atorvastatin, 40 mg daily, or without. The primary end points were changes in TDI diastolic parameters or global strain imaging diastolic parameters.
Results:
Atorvastatin reduced low-density lipoprotein cholesterol levels by 43% and high-sensitivity C-reactive protein levels by 45% (both P < .001). Follow-up TDI showed significant improvement of early mitral flow velocities divided by early diastolic peak velocities of the mitral annulus at the medial and lateral site (Nominal change for E/Emedial: -5.01 ± 6.36 vs 1.80 ± 6.59 for atorvastatin and control, respectively, P = .02). There was also a significant improvement in global strain imaging after atorvastatin treatment (global strain rate, -17.12 ± 1.42 vs -14.61 ± 1.78 for atorvastatin and control, respectively, P = .002 and E/SRIVR, 462.35 ± 110.54 vs 634.09 ± 116.81, P = .003).
Conclusions:
In this trial of PD patients without hyperlipidemia but with elevated high-sensitivity C-reactive protein levels and LVDD, atorvastatin significantly improved cardiac diastolic function (ClinicalTrials.gov number, NCT01503671).
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