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Int J Cardiol. 2018 Oct 1;268:23-26. doi: 10.1016/j.ijcard.2018.04.051. Epub 2018 Jun 18.

Impact of statin-ezetimibe combination on coronary atheroma plaque in patients with and without chronic kidney disease - Sub-analysis of PRECISE-IVUS trial.

Author information

1
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
2
Department of Cardiovascular Medicine, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
3
Matsunaga Clinic, Omuta, Japan.
4
Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
5
Interventional Cardiology Unit, New Tokyo Hospital, Matsudo, Japan.
6
Division of Coronary Heart Disease, Hyogo College of Medicine, Nishinomiya, Japan.
7
Department of Community Medicine, Kumamoto University, Kumamoto, Japan.
8
Division of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan.
9
Division of Cardiology, Health Insurance Kumamoto General Hospital, Yatsushiro, Japan.
10
Division of Cardiology, Japan Labor Health and Welfare Organization Kumamoto Rosai Hospital, Yatsushiro, Japan.
11
Department of Cardiology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
12
Division of Cardiology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
13
Division of Cardiology, Sakura Jyuji Hospital, Kumamoto, Japan.
14
Division of Cardiology, Arao Central Hospital, Arao, Japan.
15
Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan.
16
National Cerebral and Cardiovascular Center, Suita, Japan.
17
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: tsujita@kumamoto-u.ac.jp.

Abstract

BACKGROUND:

Chronic kidney disease (CKD) deteriorates the prognosis of patients undergoing percutaneous coronary intervention (PCI). Because coronary artery disease (CAD) is the major cause of death in CKD patients, cardiovascular risk reduction has been clinically important in CKD. We hypothesized intensive lipid-lowering with statin/ezetimibe attenuated coronary atherosclerotic development even in patients with CKD.

METHODS:

In the prospective, randomized, controlled, multicenter PRECISE-IVUS trial, 246 patients undergoing intravascular ultrasound (IVUS)-guided PCI were randomly assigned to receive atorvastatin/ezetimibe combination or atorvastatin alone (the dosage of atorvastatin was up-titrated to achieve the level of low-density lipoprotein cholesterol < 70 mg/dL). Serial volumetric IVUS findings obtained at baseline and 9-12 month follow-up to quantify the coronary plaque response in 202 patients were compared stratified by the presence or absence of CKD.

RESULTS:

CKD was observed in 52 patients (26%) among 202 enrolled patients. Compared with the non-CKD group, the CKD group was significantly older (71.5 ± 8.6 years vs. 64.4 ± 9.6 years, P < 0.001) with similar prevalence of comorbid coronary risk factors and lipid profiles. Similar to the non-CKD group (-1.4 [-2.8 to -0.1]% vs. -0.2 [-1.7 to 1.0]%, P = 0.002), the atorvastatin/ezetimibe combination significantly reduced ∆PAV compared with atorvastatin alone even in the CKD group (-2.6 [-5.6 to -0.4]% vs. -0.9 [-2.4 to 0.2]%, P = 0.04).

CONCLUSIONS:

As with non-CKD, intensive lipid-lowering therapy with atorvastatin/ezetimibe demonstrated stronger coronary plaque regression effect even in patients with CKD compared with atorvastatin monotherapy.

TRIAL REGISTRATION:

NCT01043380 (ClinicalTrials.gov).

KEYWORDS:

Chronic kidney disease; Coronary plaque; Ezetimibe; Intravascular ultrasound; Statins

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