NDT Advance Access originally published online on September 23, 2006
Nephrology Dialysis Transplantation 2007 22(1):118-127; doi:10.1093/ndt/gfl538
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Effect of statin treatment on renal function and serum uric acid levels and their relation to vascular events in patients with coronary heart disease and metabolic syndrome
A subgroup analysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study
1Atherosclerosis and Metabolic Syndrome Units, 2nd Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, Thessaloniki, Greece, 2Department of Clinical Biochemistry (Vascular Prevention clinics), Royal Free Hospital, Royal Free and University College Medical School, London, UK, 3Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece and 4Department of Internal Medicine, Medical School, University of Crete, Heraklion, Greece
Correspondence and offprint requests to: Moses S. Elisaf, MD, FASA, FRSH, Professor of Medicine, Department of Internal Medicine, Medical School, University of Ioannina, 451 10, Ioannina, Greece. Email: egepi{at}cc.uoi.gr; vaglimp{at}yahoo.com
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Abstract |
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Background. Metabolic syndrome (MetS) is associated with increased risk for both vascular and chronic kidney disease. Whether statins ameliorate these risks is not established.
Methods. This post hoc analysis of the GREek Atorvastatin and Coronary heart disease (CHD). Evaluation (GREACE) examines the effect of statins on estimated glomerular filtration rate (e-GFR) and serum uric acid (SUA) levels and their relation to vascular events in CHD patients with MetS. MetS patients were divided into two groups: Group A (n = 365) received lifestyle advice, target-driven treatment with statins (mainly atorvastatin) and treatment for hypertension and elevated glucose. Group B (n = 347) received the same except for statins. Patients without MetS were divided into those who received treatment similar to Group A and Group B [Groups C (n = 504) and D (n = 384), respectively]. All patients were followed for 3 years.
Results. A total of 12.1% of patients in Group A experienced a vascular event vs 28% in Group B; risk ratio (RR) 0.43, 95% confidence interval (CI) 0.20–0.64, P < 0.0001, while in those without MetS (Group C vs Group D), the respective RR was 0.59, 95% CI 0.41–0.79, P < 0.0001. In Group A, e-GFR increased by 13.7% and SUA levels fell by 8.9%, while in Group B e-GFR was reduced by 5.8% and SUA increased by 4.3% (P < 0.005). Stepwise regression analysis showed that these changes were independently related to vascular events.
Conclusion. Among CHD patients, those with MetS benefited more from statin treatment than those without MetS. This benefit could be partially attributed to favourable changes in e-GFR and SUA levels probably induced by statin treatment.
Keywords: atorvastatin; cardiovascular metabolic syndrome; chronic renal disease; coronary artery disease; glomerular filtration rate; kidney; serum uric acid; statins
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