The DOI matches its Crossref record; 22 of the 23 references it cites were found in a registry or an index.
Pravastatin for Secondary Prevention of Cardiovascular Events in Persons with Mild Chronic Renal Insufficiency
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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“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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Levey, A. S., & Coresh, J. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60178-5 · Cited by 1,841
K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients
(2005) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2005.01.019 · Cited by 1,439
Holdaas, H., Fellström, B., Jardine, A. G., Holme, I., Nyberg, G., Fauchald, P., Grönhagen-Riska, C., Madsen, S., Neumayer, H.-H., Cole, E., et al. (2003) · The Lancet · doi:10.1016/s0140-6736(03)13638-0 · Cited by 919
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Effect of Pravastatin on Cardiovascular Events in People With Chronic Kidney Disease
Tonelli, M. A., Isles, C., Curhan, G. C., Tonkin, A. M., Pfeffer, M. A., Shepherd, J., Sacks, F. M., Furberg, C. D., Cobbe, S. M., Simes, J. R., et al. (2004) · Circulation · doi:10.1161/01.cir.0000143892.84582.60 · Cited by 374
Self-citation
Metadata
- 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)
- 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
- 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
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › 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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