Statin-based therapy less effective in advanced chronic kidney disease
Statin-based therapy had a smaller effect in reducing major vascular events in patients with advanced chronic kidney disease.
Among patients with advanced chronic kidney disease, relative reductions in major vascular events observed with statin therapy became smaller as estimated glomerular filtration rate (eGFR) declined, according to data published in the Lancet Diabetes & Endocrinology.
Statin therapy is commonly used among patients with mild or moderate chronic kidney disease, but the effects of this treatment are unknown among patients with an eGFR <30 mL/min per 1.73 m2. Therefore, the Cholesterol Treatment Trialists' Collaboration conducted a meta-analysis from 28 trials that included data from 183,419 individual participants to examine the effects of statin-based therapy in this patient population.
The researchers analyzed the effect of statin-based therapy on major vascular events, including non-fatal myocardial infarction or coronary death, stroke, or coronary revascularization in patients with chronic kidney disease. The participants were subdivided based on eGFR at baseline, and the investigators estimated treatment effects with rate ratio (RR) per mmol/L reduction in LDL cholesterol.
Participants receiving statin-based therapy had a reduced risk of a first major vascular event by 21% per mmol/L reduction in LDL cholesterol (RR, 0.79). In addition, they observed smaller relative effects on vascular events as eGFR declined. The RR for eGFR ≥60 mL/min per 1.73 m2 was 0.78, 0.76 for eGFR 45 to <60 mL/min per 1.73 m2, 0.85 for eGFR 30 to <60 mL/min per 1.73 m2, 0.85 for eGFR <30 mL/min per 1.73 m2 without dialysis, and 0.94 for patients on dialysis.
The researchers also observed analogous trends for major coronary events and vascular mortality based on baseline renal function, and they noted that the risk of vascular death was reduced overall by 12%. There was no observed trend for coronary revascularization, and statin-based therapy had no effect on non-vascular mortality.
“Our results show that, even after allowing for somewhat smaller reductions in LDL cholesterol as GFR declines, there is a trend towards smaller relative risk reductions for major coronary events and strokes,” the study authors noted. “In particular, there was little evidence that statin-based therapy was effective in patients starting treatment after dialysis had been initiated.”
- Cholesterol Treatment Trialists' Collaboration. Impact of renal function on the effects of LDL cholesterol lowering with stating-based regimens: a meta-analysis of individual participant data from 28 randomized trials. Lancet Diabetes Endocrinol. 2016; doi: 10.1016/S2213-8587(16)30156-5.