[Vascular Calcification - Pathological Mechanism and Clinical Application - . The effect of cinacalcet on vascular calcification]

Abstract

Cinacalcet acts on calcium receptors (CaR) expressed on chief cells of the parathyroid gland to inhibit the secretion of parathyroid hormone (PTH) . This drug inhibits PTH secretion without causing an elevation of serum calcium and phosphorus, unlike active vitamin D. Several experimental studies demonstrated an inhibitory effect of calcimimetics on the progression of vascular calcification in animals with chronic kidney disease (CKD), in keeping with the expression of the calcium-sensing receptor (CaSR) in vascular tissue. The EVOLVE, evaluated in patients with CKD 5D the effects of the cinacalcet on the progression of vascular calcification and hard cardiovascular outcomes, respectively. The EVOLVE trials missed their respective primary end point by intent-to-treat analysis. However, recently, in order to define the frequency of fatal and nonfatal cardiovascular events attributable to atherosclerotic and nonatherosclerotic mechanisms, risk factors for these events, and the effects of cinacalcet, post hoc analysis using adjudicated data collected during the EVOLVE Trial were perfomed. In this trial, combining fatal and nonfatal cardiovascular events, randomization to cinacalcet reduced the rates of sudden death and heart failure. Patients randomized to cinacalcet experienced fewer nonatherosclerotic cardiovascular events, while the effect of cinacalcet on atherosclerotic events did not reach statistical significance.