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Cited by 278Lipoproteins and Cardiovascular HealthAcute Myocardial Infarction ResearchChronic Kidney Disease and Diabetes

Pravastatin for Secondary Prevention of Cardiovascular Events in Persons with Mild Chronic Renal Insufficiency

Tonelli, Marcello, Moy, Lemuel, Sacks, Frank M., Kiberd, Bryce, Curhan, Gary, for the Cholesterol and Recurrent Events (CARE) Trial Investigators·2003·Annals of Internal Medicine
DOI 10.7326/0003-4819-138-2-200301210-00010
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Abstract

BACKGROUND: Cardiovascular disease is a common cause of morbidity and death in persons with renal insufficiency. Although 3-hydroxy-3methylglutaryl coenzyme A reductase inhibitors (statins) are effective for secondary prevention of cardiovascular events in the general population, they have not been specifically studied in chronic renal insufficiency. OBJECTIVE: To determine whether pravastatin is effective and safe for secondary prevention of cardiovascular events in persons with chronic renal insufficiency. DESIGN: Post hoc subgroup analysis of a randomized, double-blind, placebo-controlled trial. SETTING: The Cholesterol and Recurrent Events (CARE) study, a randomized trial of pravastatin versus placebo in 4159 participants with previous myocardial infarction and total plasma cholesterol levels less than 6.21 mmol/L (<240 mg/dL). PARTICIPANTS: 1711 participants with chronic renal insufficiency defined by creatinine clearance less than or equal to 75 mL/min, using the Cockcroft-Gault equation. MEASUREMENTS: The primary outcome was death from coronary disease or symptomatic nonfatal myocardial infarction. RESULTS: After a median follow-up of 58.9 months, the incidence of the primary end point was lower in participants receiving pravastatin than in those receiving placebo (adjusted hazard ratio, 0.72 [95% CI, 0.55 to 0.95]; P = 0.02). Pravastatin was associated with lower adjusted hazard ratios for major coronary events (0.72 [CI, 0.59 to 0.88]; P = 0.001) and coronary revascularization (0.65 [CI, 0.50 to 0.83]; P = 0.001), but not total mortality (0.81 [CI, 0.61 to 1.08]; P = 0.14) or stroke (0.62 [CI, 0.39 to 1.00]; P = 0.051). Tests for interaction suggested that the observed benefit was independent of the presence and severity of renal insufficiency. Incidence of side effects was similar in persons receiving pravastatin and those receiving placebo. CONCLUSIONS: These data suggest that pravastatin is effective and appears safe for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency. Since statins may be underused in this setting, physicians should consider prescribing them for patients with chronic renal insufficiency and known coronary disease.

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  • Compared with patients with normal renal function, the risk for cardiovascular events including cerebrovascular disease, cardiac death, and total mortality increases by 2-3-fold in those with chronic kidney disease even when the chronic kidney disease is mild.

    “The results of these studies have found that, compared to patients with normal renal function, the risk for cardiovascular events, including cerebrovascular disease, cardiac death, and total mortality increases by 2–3-fold in those with CKD even when the CKD is mild.”

    From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [770]

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Authors
Tonelli, M., Moy, L., Sacks, F. M., Kiberd, B., Curhan, G., & for the Cholesterol and Recurrent Events (CARE) Trial Investigators
Affiliations
Brigham and Women's Hospital (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2003-01-21
Volume
138
Issue
2
Pages
98-104
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-138-2-200301210-00010
OpenAlex
W2089151124
Cited by
278
References
23
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 6 · 2020: 5 · 2019: 4 · 2018: 9 · 2017: 8 · 2016: 7 · 2015: 9 · 2014: 9 · 2013: 12 · 2012: 24
FWCI
25.31
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
pravastatin, chronic renal insufficiency, secondary prevention, cardiovascular events, statins, myocardial infarction, coronary revascularization, stroke, drug safety, CARE trial, Cockcroft-Gault formula, creatinine clearance, old myocardial infarction, subgroup analysis
MeSH terms
Aged, Cardiovascular Diseases, Creatinine, Double-Blind Method, Female, Humans, Kidney Failure, Chronic, Male, Middle Aged, Patient Compliance, Incidence, Pravastatin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Stroke

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