[en] Mild renal impairment is an important risk factor for late cardiovascular complications. This substudy of the Lescol Intervention Prevention Study (LIPS) assessed the effect of fluvastatin on outcome of patients who had renal dysfunction and those who did not. Complete data for creatinine clearance calculation. (Cockcroft=Gault formula) were available for 1,558 patients (92.9% of the LIPS population). Patients were randomized to fluvastatin or placebo after successful completion of a first percutaneous coronary intervention. Follow-up time was, 3 to 4 years. The effect of baseline creatinine clearance on coronary atherosclerotic events (cardiac death, non-fatal myocardial infarction, and coronary reinterventions not related to restenosis) was evaluated. Baseline creatinine clearance (logarithmic transformation) was inversely associated with an incidence of adverse events among patients who received, placebo. (hazard ratio 0.99, 95% confidence interval 0.982 to 0.998, p = 0.01). However, no association was noted between creatinine clearance and the incidence of adverse events among patients who received fluvastatin (hazard ratio 1.0, 95% confidence interval 0.99 to 1.0, p = 0.63). No further deterioration in creatinine clearance was observed during follow-up; regardless of baseline renal function or allocated treatment. Occurrence of adverse events was not related to changes in renal function during follow-up. Fluvastatin therapy markedly decreased the risk of coronary atherosclerotic events after percutaneous intervention in: patients who had lower values of creatinine clearance at baseline: The benefit of fluvastatin was unrelated to any effect on renal function. (C) 2005 by Excerpta Medica Inc.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Lemos, P. A.
Serruys, P. W.
de Feyter, P.
Mercado, N. F.
Goedhart, D.
Saia, F.
Arampatzis, C. A.
Soares, P. R.
Ciccone, M.
Arquati, M.
Cortellaro, M.
Rutsch, W.
Legrand, Victor ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
P.W. Serruys, P. de Feyter, C. Macaya, N. Kokott, J. Puel, M. Vrolix, A. Branzi, M.C. Bertolami, G. Jackson, B. Strauss, B. Meier Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial JAMA 287 2002 3215 3222
D.W. Cockcroft, M.H. Gault Prediction of creatinine clearance from serum creatinine Nephron 16 1976 31 41
P.W. Serruys, D.P. Foley, G. Jackson, H. Bonnier, C. Macaya, M. Vrolix, A. Branzi, J. Shepherd, H. Suryapranata, P.J. de Feyter A randomized placebo-controlled trial of fluvastatin for prevention of restenosis after successful coronary balloon angioplasty; final results of the fluvastatin angiographic restenosis (FLARE) trial Eur Heart J 20 1999 58 69
M.C. Morice, P.W. Serruys, J.E. Sousa, J. Fajadet, E. Ban Hayashi, M. Perin, A. Colombo, G. Schuler, P. Barragan, G. Guagliumi A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization N Engl J Med 346 2002 1773 1780
J. Al Suwaidi, D.N. Reddan, K. Williams, K.S. Pieper, R.A. Harrington, R.M. Califf, C.B. Granger, E.M. Ohman, D.R. Holmes Jr Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes Circulation 106 2002 974 980
M.G. Shlipak, P.A. Heidenreich, H. Noguchi, G.M. Chertow, W.S. Browner, M.B. McClellan Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients Ann Intern Med 137 2002 555 562
M.G. Shlipak, J.A. Simon, D. Grady, F. Lin, N.K. Wenger, C.D. Furberg Renal insufficiency and cardiovascular events in postmenopausal women with coronary heart disease J Am Coll Cardiol 38 2001 705 711
P.J. Best, R. Lennon, H.H. Ting, M.R. Bell, C.S. Rihal, D.R. Holmes, P.B. Berger The impact of renal insufficiency on clinical outcomes in patients undergoing percutaneous coronary interventions J Am Coll Cardiol 39 2002 1113 1119
M.H. Rubenstein, L.C. Harrell, B.V. Sheynberg, H. Schunkert, H. Bazari, I.F. Palacios Are patients with renal failure good candidates for percutaneous coronary revascularization in the new device era? Circulation 102 2000 2966 2972
L.A. Szczech, P.J. Best, E. Crowley, M.M. Brooks, P.B. Berger, V. Bittner, B.J. Gersh, R. Jones, R.M. Califf, H.H. Ting Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation Circulation 105 2002 2253 2258
J.F. Mann, H.C. Gerstein, J. Pogue, J. Bosch, S. Yusuf Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial Ann Intern Med 134 2001 629 636
R.J. Aviles, A.T. Askari, B. Lindahl, L. Wallentin, G. Jia, E.M. Ohman, K.W. Mahaffey, L.K. Newby, R.M. Califf, M.L. Simoons Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction N Engl J Med 346 2002 2047 2052
M. Pahor, R.I. Shorr, G.W. Somes, W.C. Cushman, L. Ferrucci, J.E. Bailey, J.T. Elam, W.B. Applegate Diuretic-based treatment and cardiovascular events in patients with mild renal dysfunction enrolled in the systolic hypertension in the elderly program Arch Intern Med 158 1998 1340 1345
M. Tonelli, L. Moye, F.M. Sacks, B. Kiberd, G. Curhan Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency Ann Intern Med 138 2003 98 104
Y. Imai, H. Suzuki, T. Saito, I. Tsuji, K. Abe, T. Saruta The effect of pravastatin on renal function and lipid metabolism in patients with renal dysfunction with hypertension and hyperlipidemia Pravastatin and Renal Function Research Group Clin Exp Hypertens 21 1999 1345 1355
A.C. Sposito, M.J. Chapman Statin therapy in acute coronary syndromes: mechanistic insight into clinical benefit Arterioscler Thromb Vasc Biol 22 2002 1524 1534
M.G. Shlipak, L.F. Fried, C. Crump, A.J. Bleyer, T.A. Manolio, R.P. Tracy, C.D. Furberg, B.M. Psaty Elevations of inflammatory and procoagulant biomarkers in elderly persons with renal insufficiency Circulation 107 2003 87 92
R.M. Henry, P.J. Kostense, G. Bos, J.M. Dekker, G. Nijpels, R.J. Heine, L.M. Bouter, C.D. Stehouwer Mild renal insufficiency is associated with increased cardiovascular mortality: the Hoorn Study Kidney Int 62 2002 1402 1407
R. Dzurik, V. Spustova, K. Janekova The prevalence of insulin resistance in kidney disease patients before the development of renal failure Nephron 69 1995 281 285
L.A. Sechi, L. Zingaro, S. De Carli, G. Sechi, C. Catena, E. Falleti, E. Dell'Anna, E. Bartoli Increased serum lipoprotein(a) levels in patients with early renal failure Ann Intern Med 129 1998 457 461
E.M. Stuveling, H.L. Hillege, S.J. Bakker, R.O. Gans, P.E. De Jong, D. De Zeeuw C-reactive protein is associated with renal function abnormalities in a non-diabetic population Kidney Int 63 2003 654 661
P. Holvoet, J. Donck, M. Landeloos, E. Brouwers, K. Luijtens, J. Arnout, E. Lesaffre, Y. Vanrenterghem, D. Collen Correlation between oxidized low density lipoproteins and von Willebrand factor in chronic renal failure Thromb Haemost 76 1996 663 669
J. Thambyrajah, M.J. Landray, F.J. McGlynn, H.J. Jones, D.C. Wheeler, J.N. Townend Abnormalities of endothelial function in patients with predialysis renal failure Heart 83 2000 205 209
D.S. Parsons, D.A. Reaveley, D.V. Pavitt, E.A. Brown Relationship of renal function to homocysteine and lipoprotein(a) levels: the frequency of the combination of both risk factors in chronic renal impairment Am J Kidney Dis 40 2002 916 923