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Abstract: PO0756

Effect of CKD Stage on Myocardial Infarction Risk with Niacin Use in Male Veterans

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Rizk, John G., Arizona State University Edson College of Nursing and Health Innovation, Phoenix, Arizona, United States
  • Soohoo, Melissa, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Hashemi, Leila, University of California Los Angeles, Los Angeles, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Niacin is a lipid therapy shown to have cardio-protective effects, particularly in those with high triglyceride (TG) and low high-density lipoprotein (HDL) levels. But, in chronic kidney disease (CKD) patients who have elevated risk of cardiovascular risk and altered lipid levels, it remains unclear if CKD stage impacts these associations.

Methods

In males with worse lipid levels (TG≥150 mg/dL or HDL ≤40 mg/dL), we matched patients with an incident niacin prescription to non-niacin users on CKD stage, TG and HDL levels. In this study of 336,178 niacin users and non-users, we evaluated the relationship of time-varying niacin use with 24-month myocardial infarction (MI) hospitalization. Cox models included adjustment for time-varying covariates and were stratified by baseline CKD stage.

Results

Patients were a mean 64 years old, with a median[IQR] of TG and HDL of 203[143, 297] and 34[29, 39] mg/dL, respectively. In unadjusted models, non-CKD, CKD 4/5 and end-stage renal disease (ESRD) niacin users had higher risks of a MI hospitalization, yet CKD 3A-3B patients had null risks, compared with non-users. With adjustment for case-mix variables, including comorbidities, we observed a linear relationship across baseline CKD stages, where risks progressively increased with worse stage. Non-CKD niacin users had lowest risks of 24-month MI hospitalization, while both CKD 4/5 and ESRD patients trended towards elevated risks of event. The relationships between niacin use and MI hospitalization remained the same with adjustment for laboratory and other lipids.

Conclusion

In time-varying analyses, niacin use was associated with lower risks of 24-month MI hospitalization in non-CKD and CKD 3A patients. The risks of MI hospitalization were progressively elevated with worse CKD stages. Additional studies are needed to further examine the relationship between lipid modulating therapies in the context of CKD patients.

Funding

  • Veterans Affairs Support