LDL Cholesterol-Lowering Therapy can Reduce Risk of Heart Disease, Stroke in Kidney Disease Patients

Through statin-based treatment, lowering LDL cholesterol did not slow kidney disease progression within five years in a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Through statin-based treatment, lowering LDL cholesterol did not slow kidney disease progression within five years in a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

The results indicate that while LDL cholesterol-lowering therapy is safe in kidney disease patients and can reduce their risk of heart disease and stroke, it does not protect their kidney health as well.

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Research has shown that lowering LDL cholesterol with statins can reduce kidney disease patients'' risk of experiencing heart attacks and strokes, but it''s not clear whether it can also reduce the risk of kidney failure, which requires dialysis or kidney transplantation, in these patients.

To investigate, researchers conducted the Study of Heart and Renal Protection (SHARP), which included 6,245 nondialysis chronic kidney disease patients who were randomized to receive a placebo or cholesterol-lowering treatment with simvastatin (a statin) plus ezetimibe (a drug that inhibits the intestinal absorption of cholesterol).

Among the major findings after 5 years of follow-up:
- Simvastatin plus ezetimibe lowered LDL cholesterol by an average of approximately 1 mmol/L (39 mg/dL) compared with placebo.
- Simvastatin plus ezetimibe did not significantly reduce the need for dialysis or transplantation (33.9% cases vs 34.6% cases in the placebo group).
- Treatment had no effect on the speed at which kidney function declined over time.

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"The SHARP trial was the largest ever randomized trial in chronic kidney disease and previously showed that simvastatin plus ezetimibe did reduce the risk of heart attack, stroke, vascular stenting, or bypass surgery, but it did not affect the risk of end-stage renal disease," said first author Richard Haynes, MRCP (University of Oxford, UK). "Statins had no effect-neither good nor bad-on kidney function."

Study co-authors include David Lewis, MRCP, Jonathan Emberson, PhD, Christina Reith, FRCP, Lawrence Agodoa, MD, Alan Cass, FRACP, Jonathan Craig, PhD, Dick De Zeeuw, MD, Bo Feldt-Rasmussen, MD, Bengt Fellstrom, MD, Adeera Levin, FRCPC, David Wheeler, FRCP, Robert Walker, FRACP, William Herrington, MD, MRCP, Colin Baigent, FRCP and Martin Landray, PhD, FRCP. The SHARP trial was conducted by an international collaboration of nephrologists and clinical trialists and was coordinated by the University of Oxford, which was the regulatory sponsor of the trial.

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Disclosures: The authors reported no financial disclosures. The Study of Heart and Renal Protection (SHARP) was initiated, conducted, and interpreted independently of the principal study funder (Merck/Schering-Plough Pharmaceuticals).

The article, entitled "Effects of Lowering LDL Cholesterol on Progression of Kidney Disease," will appear online at http://jasn.asnjournals.org/ on May 1, 2014.

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Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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