![]() National Kidney Foundation K/DOQI clinical practice guidelines for managing dyslipidemias in chronic kidney disease. Clinical epidemiology of cardiovascular disease in chronic renal disease. All rights reserved.Ĭhronic Kidney Disease Prognosis Consortium Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Merck/Schering-Plough Pharmaceuticals Australian National Health and Medical Research Council British Heart Foundation UK Medical Research Council.Ĭopyright © 2011 Elsevier Ltd. Reduction of LDL cholesterol with simvastatin 20 mg plus ezetimibe 10 mg daily safely reduced the incidence of major atherosclerotic events in a wide range of patients with advanced chronic kidney disease. There was no evidence of excess risks of hepatitis (21 vs 18 ), gallstones (106 vs 106 ), or cancer (438 vs 439, p=0♸9) and there was no significant excess of death from any non-vascular cause (668 vs 612, p=0♱3). The excess risk of myopathy was only two per 10,000 patients per year of treatment with this combination (9 vs 5 ). After weighting for subgroup-specific reductions in LDL cholesterol, there was no good evidence that the proportional effects on major atherosclerotic events differed from the summary rate ratio in any subgroup examined, and, in particular, they were similar in patients on dialysis and those who were not. ![]() Non-significantly fewer patients allocated to simvastatin plus ezetimibe had a non-fatal myocardial infarction or died from coronary heart disease (213 vs 230 RR 0♹2, 95% CI 0♷6-1♱1 p=0♳7) and there were significant reductions in non-haemorrhagic stroke (131 vs 174 RR 0♷5, 95% CI 0♶0-0♹4 p=0♰1) and arterial revascularisation procedures (284 vs 352 RR 0♷9, 95% CI 0♶8-0♹3 p=0♰036). ![]() Allocation to simvastatin plus ezetimibe yielded an average LDL cholesterol difference of 0♸5 mmol/L (SE 0♰2 with about two-thirds compliance) during a median follow-up of 4♹ years and produced a 17% proportional reduction in major atherosclerotic events (526 simvastatin plus ezetimibe vs 619 placebo rate ratio 0♸3, 95% CI 0♷4-0♹4 log-rank p=0♰021). This trial is registered at, NCT00125593, and ISRCTN54137607.Ĥ650 patients were assigned to receive simvastatin plus ezetimibe and 4620 to placebo. The key prespecified outcome was first major atherosclerotic event (non-fatal myocardial infarction or coronary death, non-haemorrhagic stroke, or any arterial revascularisation procedure). Patients were randomly assigned to simvastatin 20 mg plus ezetimibe 10 mg daily versus matching placebo. This randomised double-blind trial included 9270 patients with chronic kidney disease (3023 on dialysis and 6247 not) with no known history of myocardial infarction or coronary revascularisation. ![]() The SHARP trial aimed to assess the efficacy and safety of the combination of simvastatin plus ezetimibe in such patients. Lowering LDL cholesterol with statin regimens reduces the risk of myocardial infarction, ischaemic stroke, and the need for coronary revascularisation in people without kidney disease, but its effects in people with moderate-to-severe kidney disease are uncertain. ![]()
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