Background Limited data describe the cardiovascular benefit of HMG CoA reduc tase inhibitors(statins) in people with moderate chronic kidney disease (CKD). T he objective of this analysis was to determine whether pravastatin reduced the i ncidence of cardiovascular events in people with or at high risk for coronary di sease and with concomitant moderate CKD. Methods and Results We analyzed data f rom the Pravastatin Pooling Project(PPP), a subject level database combining re sults from 3 randomized trials of pravastatin(40mg daily) versus placebo. Of 19 700 subjects, 4491 (22.8%) had moderate CKD, defined by an estimated glomerular filtration rate of 30 to 59.99 mL/ min per 1.73 m2 body surface area. The prim ary outcome was time to myocardial infarction, coronary death, or percutaneous/s urgical coronary revascularization. Moderate CKD was independently associated wi th an increased risk of the primary outcome (adjusted HR 1.26, 95%CI 1.07 to 1. 49) compared with those with normal renal function. Among the 4491 subjects with moderate CKD, pravastatin significantly reduced the incidence of the primary ou tcome (HR 0.77, 95%CI 0.68 to 0.86), similar to the effect of pravastatin on th e primary outcome in subjects with normal kidney function (HR 0.78, 95%CI 0.65 to 0.94). Pravastatin also appeared to reduce the total mortality rate in those with moderate CKD (adjusted HR 0.86, 95%CI 0.74 to 1.00, P=0.045). Conclusions Pravastatin reduces cardiovascular event rates in people with or at risk for c oronary disease and concomitant moderate CKD, many of whom have serum creatinine levels within the normal range. Given the high risk associated with CKD, the ab solute benefit that resulted from use of pravastatin was greater than in those w ith normal renal function.
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