REVIEW ARTICLE


Statin-Induced Increase in HDL-C and Renal Function in Coronary Heart Disease Patients§ Alternate Title: Statins, HDL-C, and Renal Function



Vasilios G Athyros*, 1, Anna I Kakafika1, Athanasios A Papageorgiou1, Efstathios D Pagourelias1, Savvas D Savvatianos1, Moses Elisaf2, Asterios Karagiannis1, Konstantinos Tziomalos1, 3, Dimitri P Mikhailidis3
1 Atherosclerosis and Metabolic Syndrome Units, 2nd Propedeutic Department of Internal Medicine, Aristotelian University, Hippocration Hospital, 49 Konstantinoupoleos St, Thessaloniki 546 42, Greece
2 Department of Internal Medicine, Medical School, University of Ioannina, Greece
3 Department of Clinical Biochemistry, (Vascular Prevention Clinic) Royal Free Hospital, Royal Free and University College Medical School, Pond Street, London NW3 2QG, UK


2007 Bentham Science Publishers Ltd.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the 15 Marmara St., Thessaloniki, 551 32, Greece; Tel: + 30 2310 454237; Fax: + 30 2310 445220; E-mail: athyros@med.auth.gr


Abstract

Background: 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.

Methods and Results: In this post hoc analysis 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).

Conclusions: 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.

Keywords: Renal function, chronic kidney disease, dyslipidaemia, statins, high density lipoprotein, and coronary heart disease.