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Pravastatin for Secondary Prevention of Cardiovascular Events in Persons with Mild Chronic Renal Insufficiency

Marcello Tonelli, MD, SM; Lemuel Moyé, MD, PhD; Frank M. Sacks, MD; Bryce Kiberd, MD; Gary Curhan, MD, ScD, Cholesterol and Recurrent Events (CARE) Trial Investigators
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From University of Alberta, Edmonton, Alberta, Canada; University of Texas School of Public Health, Houston, Texas; Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; and Dalhousie University, Halifax, Nova Scotia, Canada.


Grant Support: By Bristol-Myers Squibb. Dr. Tonelli was a recipient of the Kidney Foundation of Canada/Baxter Corporation Biomedical Research Fellowship. Data analysis for this project was supported by a grant from Bristol-Myers Squibb to University of Texas School of Public Health.

Potential Financial Conflicts of Interest:Consultancies: F.M. Sacks; Honoraria: F.M. Sacks; Grants received: L. Moyé, F.M. Sacks; Other: L. Moyé.

Requests for Single Reprints: Marcello Tonelli, MD, SM, Division of Nephrology and Immunology, University of Alberta, Clinical Sciences Building, Suite 11-108C, 8440 112 Street, Edmonton, Alberta T6B 2B7, Canada.

Current Author Addresses: Dr. Tonelli: Division of Nephrology and Immunology, University of Alberta, Clinical Sciences Building, Suite 11-108C, 8440 112 Street, Edmonton, Alberta T6B 2B7, Canada.

Dr. Moyé: University of Texas School of Public Health, 1200 Herman Pressler E815, Houston, TX 77030.

Dr. Sacks: Nutrition Department, Harvard School of Public Health, 6655 Huntington Avenue, Boston, MA 02115.

Dr. Kiberd: Suite 5078, Dickson Building, 5820 University Avenue, Halifax, Nova Scotia, B3H 1V8, Canada.

Dr. Curhan: Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115.

Author Contributions: Conception and design: M. Tonelli, L. Moyé, F.M. Sacks, B. Kiberd, G. Curhan.

Analysis and interpretation of the data: M. Tonelli, L. Moyé, F.M. Sacks, B. Kiberd, G. Curhan.

Drafting of the article: M. Tonelli, L. Moyé, G. Curhan.

Critical revision of the article for important intellectual content: M. Tonelli, L. Moyé, F.M. Sacks, B. Kiberd, G. Curhan.

Final approval of the article: M. Tonelli, F.M. Sacks, B. Kiberd, G. Curhan.

Statistical expertise: L. Moyé, G. Curhan.

Administrative, technical, or logistic support: F.M. Sacks, G. Curhan.


Ann Intern Med. 2003;138(2):98-104. doi:10.7326/0003-4819-138-2-200301210-00010
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Chronic renal insufficiency is an established risk factor for cardiovascular disease, which in turn is a major cause of death in affected patients. Our results show that pravastatin reduces cardiovascular events in persons with mild chronic renal insufficiency, as defined by creatinine clearance less than or equal to 75 mL/min. The magnitude of the observed benefit from pravastatin was similar in persons with and those without renal insufficiency. Pravastatin treatment seems to reduce the incidence of cardiovascular events and coronary revascularization in persons with chronic renal insufficiency. Defining renal insufficiency in terms of glomerular filtration rate rather than creatinine clearance did not change these results.

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Figure.
Flow of participants through the study.

Inclusion criteria were age 21 to 75 years, plasma total cholesterol level < 6.21 mmol/L (<240 mg/dL), low-density lipoprotein cholesterol level 3.0 to 4.5 mmol/L (115 to 174 mg/dL), fasting triglyceride level < 4.0 mmol/L (<350 mg/dL), fasting glucose level ≤ 12.2 mmol/L (≤ 220 mg/dL), left ventricular ejection fraction ≥ 25%, and no symptomatic congestive heart failure. Serum lipid levels were measured at two or three specified visits to the clinic at least 8 weeks after hospitalization for myocardial infarction and after 4 weeks of treatment with the National Cholesterol Education Program Step 1 diet. These values were averaged to determine eligibility. CARE = Cholesterol and Recurrent Events.

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Summary for Patients

Treating Cholesterol in Patients with Mild Kidney Disease

The summary below is from the full report titled “Pravastatin for Secondary Prevention of Cardiovascular Events in Persons with Mild Chronic Renal Insufficiency.” It is in the 21 January 2003 issue of Annals of Internal Medicine (volume 138, pages 98-104). The authors are M Tonelli, L Moyé, FM Sacks, B Kiberd, and G Curhan, for the Cholesterol and Recurrent Events (CARE) Trial Investigators.

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