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Dates: 2011-2018
Funding: Merck Sharp & Dohme Corp.
Collaborators: Clinical Trials Service Unit (CTSU), University of Oxford
Project Team: Boby Mihaylova, Iryna Schlackow, Seamus Kent, Alastair Gray
Further Information Boby Mihaylova

HeartThe Study of Heart and Renal Protection (SHARP) is an international multi-centre randomized controlled trial to determine the effects of lowering LDL cholesterol with a combination of simvastatin (20mg daily) and the cholesterol-absorption inhibitor ezetimibe (10mg daily) on the risk of major atherosclerotic events (myocardial infarction or coronary death, ischaemic stroke, or any revascularisation) among patients with Chronic Kidney Disease (CKD) who do not have a history of myocardial infarction or coronary revascularisation. The study also assessed the effect of lowering cholesterol on the rate of loss of renal function in pre-dialysis patients. About 9000 patients were randomised into the study (around 6,000 of whom were not on dialysis and 3,000 on dialysis at randomisation) and all patients were followed for at least 4 years. The study showed that over a median duration of 4.9 years, allocation to ezetimibe/simvastatin produced a mean reduction of 0.85 mmol/L (33mg/dL) in LDL cholesterol, which yielded a significant 17% (RR 0.83, 95% CI 0.74-0.94) proportional reduction in major atherosclerotic events (p=0.002)

Within the programme of work on the economic analyses of SHARP the following areas have been developed:

The following topic is currently in development

  • Evaluation of lifetime cost-effectiveness of statin-based treatments in CKD


Schlackow I et al, (2019) Cost-effectiveness of lipid lowering with statins and ezetimibe in chronic kidney disease. Kidney Int. 2019; doi: 10.1016/j.kint.2019.01.028

Impact of household income on health outcomes in CKD (in collaboration with Rachael Morton and Alan Cass, University of Sydney). Kidney Int Rep. 2017 Dec;3(3):610-618. doi: 10.1016/j.ekir.2017.12.008

Schlackow I., Kent S., Herrington W., Emberson J., Haynes R., Reith C., Wanner C., Fellström B., Gray A., Landray MJ., Baigent C., Mihaylova B., SHARP Collaborative Group None. A policy model of cardiovascular disease in moderate-to-advanced chronic kidney disease Heart 2017 Aug 5. doi: 10.1136/heartjnl-2016-310970. [Epub ahead of print]   

Mihaylova B, Schlackow I, Herrington W, Lozano-Kühne J, Kent S, Emberson J, Reith C, Haynes R, Cass A, Craig J, Gray A, Collins R, Landray M, Baigent C., on behalf of the SHARP Collaborative Group. Cost-effectiveness of Simvastatin Plus Ezetimibe for Cardiovascular Prevention in CKD: Results of the Study of Heart and Renal Protection (SHARP).  American Journal of Kidney Diseases. 2015; 67(4): 576-584.

Morton RL, Schlackow I, Staplin N, Gray A, Cass A, Haynes R, Emberson J, Herrington W, Landray M, Baigent C, Mihaylova B., on behalf of the SHARP Collaborative Group. Impact of educational attainment on health outcomes in moderate-to-severe chronic kidney disease. American Journal of Kidney Diseases. 2015; 67(1): 31-39.

Kent S, Schlackow I, Lozano-Kuhne J, Reith C, Emberson J, Haynes R, Gray A, Cass A, Baigent C, Landray MJ, Herrington W, Mihaylova B., on behalf of the SHARP Collaborative Group. What is the impact of chronic kidney disease stage and cardiovascular disease on the annual cost of hospital care in moderate-to-severe kidney disease? BMC Nephrol. 2015;16(1):65.