A stepwise treatment strategy of pravastatin, vitamin E, and homocysteine lowering reduced CC-IMT (0.63 vs 0.71 mm; P<.001) and increased BA-FMD (7.56% vs 4.73%; P<.001) at 18 months.
RCT (n=93)
Double-blind
randomized
Does a stepwise treatment strategy of pravastatin, vitamin E, and homocysteine lowering improve surrogate markers of cardiovascular risk in patients with mild to moderate chronic kidney disease?
A stepwise strategy of pravastatin, vitamin E, and homocysteine lowering improved surrogate markers of cardiovascular risk (CC-IMT and BA-FMD) and reduced albuminuria in patients with mild to moderate CKD.
Absolute Event Rate: 0.63% vs 0.71%
p-value: p=<.001
BACKGROUND: Patients with chronic kidney disease have an increased risk of cardiovascular disease. Oxidative stress has been proposed to play a role in the development of cardiovascular disease among these patients. METHODS: We conducted a randomized, double-blind trial in 93 patients (Cockcroft-Gault equation: creatinine clearance, 38+/-15 mean+/-SD mL/min per 1.73 m2 0.63+/-0.25 mL/s per m2) to investigate the effect of a treatment strategy designed primarily to achieve stepwise oxidative stress reduction on common carotid intima-media thickness (CC-IMT), brachial artery flow-mediated dilatation (BA-FMD), albuminuria, and renal function. The treatment group received a regimen of pravastatin to which vitamin E supplementation was added after 6 months and homocysteine-lowering therapy after another 6 months. Blood pressure in both groups was managed according to a standard protocol. The placebo group received matching placebos. Measurement of CC-IMT and BA-FMD was performed at randomization after 6, 12, and 18 months. Patients were followed up for 2 years. Generalized estimating equations were used for analysis. RESULTS: Compared with placebo, active treatment was associated with a decrease in CC-IMT (after 18 months: from 0.68 to 0.63 mm in the treatment group and from 0.65 to 0.71 mm in the placebo group; P<.001), an increase in BA-FMD (after 18 months: from 4.66% to 7.56% in the treatment group and from 6.21% to 4.73% in the placebo group; P<.001), and an attenuated increase in urinary albumin excretion over time (P=.04 for between-group difference after 24 months), but no effect was observed on renal function. CONCLUSION: In patients with mild to moderate chronic kidney disease, 18 months of a treatment strategy along with well-controlled blood pressure reduced CC-IMT and urinary albumin excretion and increased BA-FMD. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00384618.
Prabath W.B. Nanayakkara (Mon,) conducted a rct in mild to moderate chronic kidney disease (n=93). pravastatin, vitamin E, and homocysteine-lowering therapy vs. placebo was evaluated on common carotid intima-media thickness (CC-IMT) (p=<.001). A stepwise treatment strategy of pravastatin, vitamin E, and homocysteine lowering reduced CC-IMT (0.63 vs 0.71 mm; P<.001) and increased BA-FMD (7.56% vs 4.73%; P<.001) at 18 months.
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