Low-density lipoprotein (LDL) cholesterol lowering in chronic kidney disease (CKD) looks SHARP

While the cardiovascular benefits of LDL cholesterol lowering in patients without kidney disease are well established, the effects on people with moderate to severe kidney disease have remained unproven.

The Study of Heart and Renal Protection (SHARP) was a randomised double-blind trial that included 9270 patients with CKD (3023 of whom were on dialysis) and with no known history of cardiovascular disease. Patients were randomly assigned to either placebo or a combination of simvastatin 20 mg once daily plus ezetimibe 10 mg once daily. The main outcome measure was defined as a first major cardiovascular event (fatal or non-fatal myocardial infarction, ischaemic stroke or any arterial revascularisation procedure).

In the study, 4650 patients were assigned to receive simvastatin plus ezetimibe, and 4620 received placebo; those who received the LDL-lowering drugs demonstrated an average LDL cholesterol difference of 0.85 mmol/L over a median follow-up of 4.9 years. This translated into a 17% proportional reduction in major atherosclerotic events (526 (11.3%) simvastatin plus ezetimibe vs 619 (13.4%) placebo; rate ratio …