Does treatment of dyslipidemia reduce the risk of CVD events and mortality in patients with CKD?
The 10-year cardiovascular risk for most adults over the age of 50 years with CKD is >10%, thereby meeting the general population requirements for statin therapy.
Data supporting the use of statins in the primary prevention of CVD comes primarily from post hoc analysis of trials of the general population. A meta-analysis of 50 such trials, which included 45,285 participants with stage 3 or 4 CKD, reported a significant reduction in all-cause and cardiovascular mortality and nonfatal CVD outcomes.
The best randomized controlled trial (RCT) evidence in patients with CKD comes from the Study of Heart and Renal Protection (SHARP) trial, which is the only randomized trial to focus on statin therapy for the primary prevention of CVD events and mortality in patients with kidney disease.
The SHARP trial included 9438 participants with CKD with a mean estimated glomerular filtration rate (eGFR) of 27 mL/min per 1.73 m². Participants were randomized to either simvastatin 20 mg, ezetimibe 10 mg, or placebo. Among 6247 SHARP participants with CKD not on dialysis, there was a reduced incidence of CVD mortality, nonfatal myocardial infarction, and stroke (9.5% vs. 11.9%) among patients treated with simvastatin and ezetimibe compared to placebo.
Whether combination therapy with ezetimibe is superior to monotherapy with statins in CKD patients is yet unknown.
