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BMJ 2011; 342 doi: (Published 15 June 2011) Cite this as: BMJ 2011;342:d3671

Cholesterol reduction is worth while for adults with chronic kidney disease

The latest trial to test cholesterol lowering for adults with chronic kidney disease suggests that a low dose of simvastatin combined with the cholesterol absorption inhibitor ezetimibe reduces the risk of atherosclerotic events by 17% compared with a placebo (11.3% v 13.4%; rate ratio 0.83, 95% CI 0.74 to 0.94). The combination didn’t save any lives, and its main effect was to reduce arterial revascularisation procedures (6.1% v 7.6%; 0.79, 0.68 to 0.93) and ischaemic strokes (2.8% v 3.8%; 0.75, 0.60 to 0.94). A linked comment (doi:10.1016/S0140-6736(11)60822-2) endorses the findings as clear evidence of benefit, the first so far from a series of four large trials of statins in adults with primary renal disease.

The 9270 participants had chronic kidney disease of varying severity, and a third were on dialysis from the start (mostly haemodialysis). More than 2000 others progressed to end stage renal disease during the trial. Active treatment with simvastatin plus ezetimibe did not prevent or slow progression.

The authors chose this particular combination to maximise benefits and minimise side effects. Patients taking it had no more hepatic, biliary, or muscle pathology than controls taking placebo, and no more cancers. Treatment looks safe, says the linked comment, and doctors could start by giving cholesterol lowering drugs to patients not yet on dialysis. Results for the subgroup on lifelong dialysis at the start of the trial were inconclusive.

Quitting is good, not starting at all is better


Smoking cigarettes increases a woman’s risk of symptomatic peripheral artery disease (PAD). The more she smokes, the higher the risk. The longer she smokes, the higher the risk. A large observational study of female US health professionals reports a hazard ratio close to 17 for women smoking 15 or more cigarettes a day compared …

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