Statin-Induced Increase in HDL-C and Renal Function in Coronary Heart Disease Patients.
Statin-Induced Increase in HDL-C and Renal Function in Coronary Heart Disease Patients.
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DOI：
10.2174/1874192400701010008
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发表时间：
2007
影响因子：
0.8
通讯作者：
Mikhailidis, Dimitri P
中科院分区：
文献类型：
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作者：
Athyros, Vasilios G;Kakafika, Anna I;Papageorgiou, Athanasios A;Pagourelias, Efstathios D;Savvatianos, Savvas D;Elisaf, Moses;Karagiannis, Asterios;Tziomalos, Konstantinos;Mikhailidis, Dimitri P
关于他汀类药物诱导的高密度脂蛋白胆固醇（HDL-C）升高改善冠心病（CHD）患者肾功能的可能性知之甚少。 在对希腊阿托伐他汀和冠心病评估（GREACE）研究的分析中，我们研究了他汀类药物治疗后HDL-C升高对肾功能的影响。在总共1,600名患者中，880名接受了各种他汀类药物（主要是阿托伐他汀），720名没有接受。两组的其他二级预防治疗相似。随访3年后，他汀类药物未治疗组的血脂水平无变化，估计肾小球滤过率（eGFR）较基线降低5.1%（P<0.0001）。相比之下，在他汀类药物治疗组中，非HDL-C降低43%，HDL-C升高7%，eGFR与基线相比显著升高9.8%（P<0.0001）。在多元回归分析中，整个研究期间治疗组HDL-C平均升高7%与治疗第6周后记录的eGFR升高5.6%相关。他汀类药物诱导的HDL-C每升高5%，eGFR升高的比值比为1.78（95%置信区间1.19-3.34; P=0.001）。他汀类药物治疗显着改善肾功能。他汀类药物诱导的HDL-C升高显著且独立地促进了这种改善。这一发现支持了这样一个概念，即改善低密度脂蛋白胆固醇以外的脂质变量也有利于保护肾功能。
Little is known about the potential of statin-induced high-density lipoprotein cholesterol (HDL-C) increase to improve renal function in coronary heart disease (CHD) patients. In thispost hocanalysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study we investigated the effect of HDL-C increase after statin treatment on renal function. From a total of 1,600 patients, 880 were on various statins (mainly atorvastatin) and 720 were not. Other secondary prevention therapies were similar in the 2 groups. After a 3 year follow up, the lipid profile was unchanged in the statin untreated group and estimated glomerular filtration rate (eGFR) was reduced by 5.1% compared with baseline (P<0.0001). In contrast, in the statin treated group non-HDL-C was reduced by 43%, HDL-C was increased by 7% and there was a significant increase in eGFR compared with baseline by 9.8% (P<0.0001). In multiple regression analysis, the mean 7% increase in HDL-C in the treated arm during the entire study was associated with a 5.6% increase in eGFR recorded after the 6th week of treatment. The odds ratio of eGFR increase with every 5% statin-induced rise in HDL-C was 1.78 (95% confidence interval 1.19-3.34; P=0.001). Statin treatment significantly improved renal function. Statin-induced HDL-C increase significantly and independently contributed to this improvement. This finding supports the concept that improving lipid variables other than low density lipoprotein cholesterol is also beneficial to preserving renal function.