Re: Atorvastatin Appears Safe at High Doses

jason@xxxxxxxxxx (Jason) wrote in news:jason-2503061254590001@66-52-22-
5.lsan.pw-dia.impulse.net:

Bill,
There have been lots of clinical trials related to statins. I don't
claim
to know the details related to all of them. I have read about SOME of
those clinical trials related to statins and in each case--they
elimated
from the trials anyone that had kidney problems or liver problems. I
call
it cherry picking. However, I could understand if someone would
disagree
with me. One poster told me that the reason they do it this way was to
test the statins on "normal" people with no health problems instead of
on
people with all sorts of medical problems--There are medical reasons
for
doing it this way.
I believe that statins should be tested (in the trials) on people with
all
sorts of medical problems--including kidney disease. However, those
people
that have liver disease should be excluded from the trials since
medical
experts know that statins could kill those people.
Jason
Jason



"The role of statins in chronic kidney disease."

Am J Med Sci. 2005; 330(2):69-81 (ISSN: 0002-9629)
Agarwal R; Curley TM
Division of Nephrology, Department of Medicine, Indiana University School
of Medicine, Indianapolis, 46202, USA. ragarwal@xxxxxxxxx

Chronic kidney disease is associated with cardiovascular event rates that
are at least as high as in patients with established atherosclerotic
cardiovascular disease or in those with diabetes mellitus. Chronic kidney
disease is therefore considered a cardiovascular disease risk equivalent.
Treatment of dyslipidemia, which is very common in this population and
reflects the pattern seen in the metabolic syndrome, reduces
cardiovascular events in patients with chronic kidney disease. Thus,
patients with chronic kidney disease should be evaluated and treated for
dyslipidemia. Dyslipidemia is a risk factor for the development of
impaired kidney function. Dyslipidemia is also associated with
progressive renal disease in subjects with no overt renal disease, as
well as those with diabetic and nondiabetic kidney disease. Although
definitive randomized controlled trials are lacking, the collective
evidence suggests that treatment of dyslipidemia is associated with less
decline in renal function. The use of potent statins in high doses can
lead to transient proteinuria via impairment of proximal tubular
receptor--mediated endocytosis, in a dose-dependent manner. Over the long
term, however, the use of statins results in a reduction in proteinuria
and in the rate of decline of renal function. Several large definitive
trials that are currently underway to examine the safety and efficacy of
statins in cardiovascular and renal protection should provide more
definitive answers on the role of these drugs in this very high risk
population.

=====================================================================
Statins Reduce Heart Risk in Diabetic Patients with Chronic Kidney
Disease

WASHINGTON, DC -- October 26, 2005 -- The cholesterol-lowering drug
pravastatin is highly effective in lowering the risk of heart attack and
other cardiovascular events in patients with diabetes and chronic kidney
disease (CKD), reports a study in the December Journal of the American
Society of Nephrology.

An international research team led by Dr. Marcello Tonelli of University
of Alberta, Edmonton, analyzed nearly 20,000 patients from three major
studies of pravastatin. Pravastatin is one of the widely used
cholesterol-lowering HMG-CoA reductase inhibitor drugs, commonly known as
"statins."

About 3% of the patients had both CKD and diabetes -- both strong risk
factors for cardiovascular events and diseases that together affect
several million Americans. Rates of cardiovascular events -- including
myocardial infarction (heart attack), death from heart disease, or
surgery for heart disease -- were compared among the different risk
factor groups.

Pravastatin reduced the cardiovascular event rate in all groups. The
percentage reduction in diabetic patients with CKD was 25%, compared to
24% in patients with neither risk factor.

Diabetes is a major risk factor for CKD, and both are risk factors for
heart disease. The cholesterol-lowering statin drugs have been shown to
help prevent cardiovascular events in many groups of patients, including
those with pre-existing heart disease. However, previous to the new
study, their effectiveness in patients with diabetes and/or CKD was
uncertain.

Patients with CKD have gradual, irreversible declines in kidney function.
Affecting nearly 10 million Americans, CKD increases the risk of
cardiovascular disease and other health problems. Studies have shown that
appropriate early screening and treatment can reduce the increased risk
of cardiovascular disease, as well as the risk of renal failure, in
patients with CKD. The new results suggest that, as in other groups,
statin treatment for diabetic patients with CKD reduces the relative risk
of cardiovascular events by about one-fourth. Because patients with
diabetes and CKD are a particularly high-risk group, the absolute
benefits of statin treatment are even greater. "[M]ore widespread use of
statins in this population would likely result in a clinically important
benefit," the researchers conclude.

SOURCE: American Society of Nephrology
===================================================================

http://www.aafp.org/afp/20041115/1921.html

"Fibrates are known to decrease triglyceride levels, but they may
increase the risk for rhabdomyolysis in patients with chronic kidney
disease. Statins can lower cholesterol levels safely and effectively in
these patients, although research has not yet shown that treatment
decreases cardiovascular mortality.34"
======================================================================


.

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