Intestinal cholesterol absorption, treatment with atorvastatin, and cardiovascular risk in hemodialysis patients.

Silbernagel, Günther; Fauler, Günter; Genser, Bernd; Drechsler, Christiane; Krane, Vera; Scharnagl, Hubert; Grammer, Tanja B; Baumgartner, Iris; Ritz, Eberhard; Wanner, Christoph; März, Winfried (2015). Intestinal cholesterol absorption, treatment with atorvastatin, and cardiovascular risk in hemodialysis patients. Journal of the American College of Cardiology, 65(21), pp. 2291-2298. Elsevier 10.1016/j.jacc.2015.03.551

Text 1-s2.0-S073510971501668X-main.pdf - Published Version Restricted to registered users only Available under License Publisher holds Copyright. Download (864kB) | Request a copy

BACKGROUND

Hemodialysis patients are high absorbers of intestinal cholesterol; they benefit less than other patient groups from statin therapy, which inhibits cholesterol synthesis.

OBJECTIVES

This study sought to investigate whether the individual cholesterol absorption rate affects atorvastatin's effectiveness to reduce cardiovascular risk in hemodialysis patients.

METHODS

This post-hoc analysis included 1,030 participants in the German Diabetes and Dialysis Study (4D) who were randomized to either 20 mg of atorvastatin (n = 519) or placebo (n = 511). The primary endpoint was a composite of major cardiovascular events. Secondary endpoints included all-cause mortality and all cardiac events. Tertiles of the cholestanol-to-cholesterol ratio, which is an established biomarker of cholesterol absorption, were used to identify high and low cholesterol absorbers.

RESULTS

A total of 454 primary endpoints occurred. On multivariate time-to-event analyses, the interaction term between tertiles and treatment with atorvastatin was significantly associated with the risk of reaching the primary endpoint. Stratified analysis by cholestanol-to-cholesterol ratio tertiles confirmed this effect modification: atorvastatin reduced the risk of reaching the primary endpoint in the first tertile (hazard ratio [HR]: 0.72; p = 0.049), but not the second (HR: 0.79; p = 0.225) or third tertiles (HR: 1.21; p = 0.287). Atorvastatin consistently significantly reduced all-cause mortality and the risk of all cardiac events in only the first tertile.

CONCLUSIONS

Intestinal cholesterol absorption, as reflected by cholestanol-to-cholesterol ratios, predicts the effectiveness of atorvastatin to reduce cardiovascular risk in hemodialysis patients. Those with low cholesterol absorption appear to benefit from treatment with atorvastatin, whereas those with high absorption do not benefit.

Interest & Impact

Downloads

2 since deposited on 03 Jul 2015
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item