Ezetimibe and Simvastatin in Chronic Kidney Disease: Good News
The SHARP study was reported at the American Society of Nephrology Meeting in Denver on November 20th, 2010. The results are positive. This is excellent news indeed when previous lipid trials in patients with renal failure were a disappointment.
Here is a summary of the key findings:
- The patients allocated to take ezetimibe plus simvastatin had one-sixth fewer heart attacks, strokes or operations to unblock arteries ("major atherosclerotic events"), with similar reductions observed in all types of patient studied.
- During this long trial, the proportion of patients who stopped taking their allocated treatment was about one third, but this was not generally due to side-effects and was the same for both real and dummy treatments. If taken without interruption, however, ezetimibe plus simvastatin could have even larger effects than were seen in SHARP, potentially reducing risk by about one quarter.
- Adding 10mg daily of ezetimibe to 20mg daily of simvastatin produced a large reduction in LDL cholesterol safely. This combination treatment may be particularly good for kidney patients, as it avoids the possibility of side-effects with high statin doses.
- There was no support for previous concerns with ezetimibe about possible adverse effects on cancer, and no evidence of an increased risk of muscle or liver problems.
As with any study, a complete critical appraisal should be done on the published article once available. One key question is whether the observed benefit was the result of ezetimibe or simply the result of lower LDL in the treatment group, regardles how obtained (i.e. with higher statin dosing).