Effect of Lovastatin on Primary Prevention of Cardiovascular Events in Mild CKD and Kidney Function Loss: A Post Hoc Analysis of the Air Force/Texas Coronary Atherosclerosis Prevention Study

Background

Chronic kidney disease (CKD) is associated with an increased risk of incident cardiovascular disease (CVD); however, the role of statins for the primary prevention of acute cardiovascular events in patients with CKD and the effect of statins on kidney function loss in persons without prevalent CVD have not been studied.

Study Design

Post hoc analysis of the Air Force/Texas Coronary Atherosclerosis Prevention Study.

Setting & Participants

Multicenter, randomized, double-blind, placebo-controlled trial of 5,608 men and 997 women without CVD randomly assigned to treatment with lovastatin or placebo.

Intervention

Placebo or lovastatin, 20 mg/d.

Outcomes & Measurements

First major acute cardiovascular event in participants with mild CKD and kidney function loss in persons with or without CKD. Estimated glomerular filtration rate was calculated using the 4-variable Modification of Diet in Renal Disease Study equation.

Results

At baseline, mean estimated glomerular filtration rate in participants with CKD (n = 304) was 53.0 ± 6.0 mL/min/1.73 m². After an average follow-up of 5.3 ± 0.8 years, the incidence of a fatal and nonfatal CVD event was lower in participants with CKD receiving lovastatin than in those receiving placebo (adjusted relative risk [RR], 0.31; 95% CI, 0.13-0.72; P = 0.01). Tests for interaction suggested that the benefit of lovastatin was independent of the presence of CKD. Lovastatin did not reduce the annualized mean decrease in estimated glomerular filtration rate (−1.3 ± 0.07 vs −1.4 ± 0.07 mL/min/1.73 m²/y, respectively; P = 0.1) or the frequency of a ≥ 25% decrease in kidney function (adjusted RR, 1.10; 95% CI, 0.96-1.28; P = 0.2) or incident CKD (adjusted RR, 1.04; 95% CI, 0.86-1.27; P = 0.6).

Limitations

Unable to determine the cause and duration of kidney disease, and information regarding proteinuria was not available.

Conclusions

Lovastatin is effective for the primary prevention of CVD in patients with CKD, but is not effective in decreasing kidney function loss in persons with no CVD.

Index Words: Statins, cardiovascular disease, kidney disease progression, primary prevention