Abstract: TH-PO457

Intensity of Statin Therapy and All-Cause Mortality in CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States
  • Richardson, Peter, Baylor College of Medicine, Houston, Texas, United States
  • Niu, Jingbo, Baylor College of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Virani, Salim S, Baylor College of Medicine, Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background

KDIGO guidelines recommend statin therapy for primary or secondary prevention of vascular events in most persons with non-dialysis CKD, at doses which would be categorized as moderate-intensity by the 2013 AHA/ACC lipid guideline. It is unclear whether persons with CKD would benefit from higher intensity statin therapy given the potential higher risks of adverse events. We examined the association between incident statin therapy intensity and all-cause mortality in a non-dialysis CKD population.

Methods

Incident statin users were identified from a cohort of persons with sustained low eGFR (<60 for ≥90 days) receiving care through the Veterans Administration from 2005-08. The cohort was limited to those with filled prescriptions covering ≥67% of days in the first year of use. Exposure was categorized by preponderant dose intensity (high, moderate, low by AHA/ACC guideline) during the first year. The outcome was all-cause mortality following the exposure period. Patients were censored at last VA follow-up or 5 years. We used Cox proportional hazards regression adjusted for relevant covariates.

Results

Of 40,241 persons included, 33.9% received low-, 59.9% received moderate-, and 6.2% received high-intensity statin therapy. Median age [IQR] was 76 [66-82] years, 32.2% had diabetes, and 91.4% were CKD stage 3. High-intensity users were younger (median age 74) and more likely to have diabetes (34.6%). During 167,850 person-years of follow up 10,753 persons (26.7%) died. Unadjusted mortality was lower in the high-dose group. After multivariable regression adjustment, mortality risk did not differ across the high-, medium-, and low-intensity groups.

Conclusion

In an older, non-dialysis CKD population of US Veterans, statin therapy intensity over one year was not independently associated with all-cause mortality. This real-world analysis supports the KDIGO lipid guideline, which recommends doses of moderate intensity, although the question of whether lower intensity therapy might be equally effective is raised.

Statin intensityPatients (N)Events (N [%])Event rate (per 100 person-years)HR* (95% CI)
Low136293756 (27.6)6.441 (ref)
Moderate241196461 (26.8)6.411.03 (0.99-1.07)
High2493536 (21.5)6.191.05 (0.96-1.15)

*Adjusted for age, CKD stage, BMI, SBP, DBP, ACEI/ARB, LDL, trig., DM, CHD, cerebrovasc. dis., PVD, COPD, CHF, malignancy