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Influence of pre-existent albuminuria on the efficacy of statins

Comment by Eugenio Greco, EACPR PEP Section and Paul Dendale, EACPR Secretary

Prevention


In this study, the authors investigated whether subjects with hypercholesterolemia will benefit more from starting statin treatment in the case of high albuminuria and/or high-sensitivity C-reactive protein (hsCRP), because it is not clear which hypercholesterolemic patients benefit most from β-hydroxy-β-methylglutaryl coenzyme A reductase inhibitors with respect to the prevention of cardiovascular events.

The authors compared the data of 2011 subjects who had hypercholesterolemia at baseline, a negative cardiovascular disease history and who were not treated with statins: 695 subjects started with a statin during a follow-up of 7.0 ± 1.7 years.

Adjusted hazard ratios for cardiovascular events were calculated in subjects who started versus those who did not start a statin stratified for albuminuria less than or ≥ 15 mg/day and/or hsCRP less than or ≥ 3 mg/L.

The results were that the start of a statin was associated with a beneficial effect on cardiovascular risk in subjects with high albuminuria, while the effect of starting a statin was non-significant in subjects with low albuminuria.

The effect of starting a statin was similar in subgroups with high and low hsCRP.

When combining albuminuria and hsCRP subgroups, the start of statin treatment was associated with a lower risk of cardiovascular events dependent on albuminuria and not on the hsCRP level.

This is of course a post-hoc analysis of a non-randomised cohort, so any conclusions should be considered hypothesis generating. If proven correct, this would mean that patients that have already signs of vascular damage such as albuminuria have a stronger indication for statins.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology