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Ελληνική Επιθεώρηση Αθηροσκλήρωσης 3(4)
ΑΑ13 IMPROVING THE IMPLEMENTATION OF CURRENT GUIDELINES FOR THE MANAGEMENT OF FOUR MAJOR CORONARY ARTERY DISEASE RISK FACTORS BY VEERING OLD HABITS: THE IMPERATIVE RENAL ANALYSIS V.G. Athyros, A.I. Hatzitolios, A. Karagiannis, N. Katsiki, K. Tziomalos, D. Petridis, C. Savopoulos, T.D. Didangelos, A. Kakafika, D.P. Mikhailidis, for the IMPERATIVE Collaborative Group 2nd DYPE, Hellenic Atherosclerosis Society, Greek Society of General Practitioners Background-Aim: To prospectively assess the short-term effect of multifactorial treatment on renal function and serum uric acid levels (SUA) in patients with stage 3 chronic kidney disease (CKD) and multiple cardiovascular disease (CVD) risk factors, including dyslipidemia, diabetes mellitus, arterial hypertension or metabolic syndrome. Methods: This is joint post hoc analysis of 5 different “best practice” studies that included 4,083 patients with multiple CVD risk factors. Estimated glomerular filtration rate (eGFR) was assessed using the MDRD formula. Stage 3 CKD patients were characterized those with an eGFR ranging from 30–59 mL/min/1.73 m2. There was a baseline visit, followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimize drug treat-
ment for all vascular risk factors. After 6 months the patients were re-evaluated. Results: From 4,083 patients 1,235 had stage 3 CKD (30%). Treatment strategy induced an enhanced compliance to lifestyle measures and use of evidence-based medication, including a statin. Multifactorial treatment was related to an increase in eGFR by 5.6% (p<0.001) in those patients and a reduction by 6.1% (p<0.001) in SUA levels. From patients 127 (10%) returned to stage 2 CKD and only 9 (0.7%) advanced to stage 4 CKD by the end of the 6-month study period. There were no major side-effect of drug treatment. Conclusions: Multitargeted treatment in patients with several CVD risk factors may improve renal function and reduce SUA as soon as 6 months, offsetting thus early two potential CVD risk factors in patients already exposed to high CVD risk.
ΑΑ14 SAFETY AND IMPACT ON CARDIOVASCULAR EVENTS OF LONG-TERM STATIN TREATMENT IN PATIENTS WITH CORONARY HEART DISEASE AND ABNORMAL LIVER FUNCTION TESTS: A POST HOC ANALYSIS OF THE GREACE STUDY V.G. Athyros,1 K. Tziomalos,2 T. Gossios,3 T. Griva,1 P. Anagnostis,4 K. Kargiotis,1 E. Pagourelias,3 E. Theocharidou,1 A. Karagiannis1 D.P. Mikhailidis5 1 Β' Προπαιδευτική Παθολογική Κλινική ΑΠΘ, «Ιπποκράτειο» Νοσοκομείο, Θεσσαλονίκη, 2Α' Προπαιδευτική Παθολογική Κλινική ΑΠΘ, Νοσοκομείο ΑΧΕΠΑ, Θεσσαλονίκη, 3Α' Καρδιολογική Κλινική ΑΠΘ, Νοσοκομείο ΑΧΕΠΑ, Θεσσαλονίκη, 4Ενδοκρινολογική Κλινική, «Ιπποκράτειο» Νοσοκομείο, Θεσσαλονίκη, 5Department Of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London, London, Uk
Background-Aim: To evaluate the safety and impact on cardiovascular morbidity and mortality of long-term statin treatment in patients with coronary heart disease and abnormal liver function tests (LFTs). Patients-methods: This is a post hoc analysis of the GREek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study. All patients of the GREACE study (n=1,600) were included in this analysis. Results: Liver-related adverse effects of statin treatment were infrequent (0.08%). Among patients with abnormal LFTs at baseline [possibly associated with non-alcoholic fatty liver disease (NAFLD) as diagnosed by ultrasonography], those treated with a statin (mainly atorvastatin 24 mg/d, n=227) exhibited a substantial improvement in LFTs whereas those
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not treated with statins (n=210) showed further worsening of LFTs. Cardiovascular events occurred in 22/227 patients with abnormal LFTs who were treated with a statin (3.2 events/100 patient years) and in 63/210 patients with abnormal LFTs who did not receive statins (10 events/100 patient years; 68% relative risk reduction (RRR), p<0.0001]. This cardiovascular benefit was greater (p=0.0074) than in patients with normal LFTs [90/653 events in statin-treated patients (4.6/100 patient years) vs 117/510 events in statin-untreated patients (7.6/100 patient years; 39% RRR, p<0.0001)]. Conclusions: Statin treatment is safe, can improve LFTs and reduce cardiovascular morbidity in patients with mild to moderately abnormal LFTs possibly due to NAFLD.