The cholesterol-lowering drug pravastatin is highly effective in lowering the risk of Heart Attack and other cardiovascular events in patients with Diabetes and chronic kidney disease (CKD), reports a study in the December Journal of the American Society of Nephrology.
An international research team led by Dr. Marcello Tonelli of University of Alberta, Edmonton, analyzed nearly 20,000 patients from three major studies of pravastatin. Pravastatin is one of the widely used cholesterol-lowering HMG-CoA reductase inhibitor drugs, commonly known as “Statins.”
About three percent of the patients had both CKD and Diabetes - both strong risk factors for cardiovascular events and diseases that together affect several million Americans. Rates of cardiovascular events - including Myocardial Infarction (Heart Attack), death from Heart disease, or surgery for heart disease - were compared among the different risk factor groups.
Pravastatin reduced the cardiovascular event rate in all groups. The percentage reduction in diabetic patients with CKD was 25 percent, compared to 24 percent in patients with neither risk factor.
A heart attack occurs when one of the heart’s coronary arteries is blocked suddenly, usually by a tiny blood clot (thrombus). A heart attack also is called a myocardial infarction or coronary thrombosis. The blood clot typically forms inside a coronary artery that already has been narrowed by atherosclerosis, a condition in which fatty deposits (plaques) build up along the inside walls of blood vessels.
Each coronary artery supplies blood to a specific part of the heart’s muscular wall, so a blockage in an artery causes pain and malfunction in the area it supplies. Depending on the location and amount of heart muscle involved, this malfunction can seriously interfere with the heart’s ability to pump blood. Also, some of the coronary arteries supply areas of the heart that regulate heartbeat, so a blockage sometimes results in potentially fatal abnormal heartbeats, called cardiac arrhythmias. The pattern of symptoms that develops with each heart attack and the chances of survival are linked to the location and extent of the coronary artery blockage.
Diabetes is a major risk factor for CKD, and both are risk factors for Heart disease. The cholesterol-lowering Statin drugs have been shown to help prevent cardiovascular events in many groups of patients, including those with pre-existing heart disease. However, previous to the new study, their effectiveness in patients with Diabetes and/or CKD was uncertain.
Heart disease is any disorder that affects the heart’s ability to function normally. The most common cause of heart disease is narrowing or blockage of the coronary arteries, which supply blood to the heart itself. This happens slowly over time.
Some heart diseases can be present at birth (congenital heart diseases).
Other causes include the following:
- Abnormal function of the heart valves
- Abnormal electrical rhythm of the heart
- Weakening of the heart’s pumping function caused by infection or toxins
Patients with CKD have gradual, irreversible declines in kidney function. Affecting nearly 10 million Americans, CKD increases the risk of cardiovascular disease and other health problems. Studies have shown that appropriate early screening and treatment can reduce the increased risk of cardiovascular disease, as well as the risk of renal failure, in patients with CKD.
The new results suggest that, as in other groups, statin treatment for diabetic patients with CKD reduces the relative risk of cardiovascular events by about one-fourth. Because patients with Diabetes and CKD are a particularly high-risk group, the absolute benefits of statin treatment are even greater. “More widespread use of statins in this population would likely result in a clinically important benefit,” the researchers conclude.
The ASN is a not-for-profit organization of 9,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases.
Revision date: June 18, 2011
Last revised: by Andrew G. Epstein, M.D.