Benefits of lowering cholesterol in chronic kidney disease/Authors' reply

• Published in: The Lancet (British edition) 2011-10, Vol.378 (9800), p.1375
• Main Authors: Lui, Philip, de Tena, Jaime García, Abejón, Laura, Bernal, David, Águila, Estefanía, Rodríguez-Zapata, Manuel, Mascitelli, Luca, Goldstein, Mark R, Al-Rasadi, Khalid, Banerjee, Yajnavalka, Baigent, Colin, Landray, Martin J, Reith, Christina, Emberson, Jonathan, Collins, Rory
• Format: Article
• Language: English
• Subjects: Cardiovascular disease; Cholesterol; Dialysis; Heart attacks; Kidney diseases; Kidneys; Mortality; Statins
• ISSN: 0140-6736; 1474-547X

Sudden statin withdrawal has been implicated in increased morbidity and mortality compared with continuation of statin in patients with acute coronary syndromes.2-4 Small studies in healthy individuals and in animals have also suggested a rapid loss of anti-inflammatory activity and, in some instances, a transient period of prothrombotic activity associated with discontinuation of statin therapy.5 The low-grade inflammation associated with chronic kidney disease might have amplified the effect of statin withdrawal in the SHARP study. Furthermore, despite achieving an enhanced reduction of LDL cholesterol by adding ezetimibe to statins, the results of previous trials on surrogate markers of cardiovascular outcomes in patients without kidney disease4,5 raise doubts about whether trials such as SHARP show additional benefit from ezetimibe beyond that expected with a statin alone. Among patients who were not on dialysis at randomisation, SHARP did not find any evidence that simvastatin (in combination with ezetimibe) increased the incidence of acute renal failure or progression to end-stage kidney disease.1 The SHARP results show, therefore, that a substantial reduction in cholesterol safely reduces the risk of major atherosclerotic events in patients with CKD, and that appropriately widespread use of such treatment would be beneficial for this high-risk group of patients.