Abstract: SA-PO516
Comparative Safety and Effectiveness of Statins in Kidney Transplant Recipients
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Bae, Sunjae, New York University Grossman School of Medicine, New York, New York, United States
- Schnitzler, Mark, Saint Louis University, Saint Louis, Missouri, United States
- Lentine, Krista L., Saint Louis University, Saint Louis, Missouri, United States
- Segev, Dorry L., New York University Grossman School of Medicine, New York, New York, United States
- McAdams-DeMarco, Mara, New York University Grossman School of Medicine, New York, New York, United States
Background
Recent observational studies suggest that statins are well-tolerated and may lower all-cause mortality in kidney transplant recipients. A specific type of statin may be preferrable over other types, given the unique pathophysiological challenges in this population. We compared the safety and effectiveness outcomes between statins in a national cohort.
Methods
Using the USRDS data, we studied adult kidney transplant recipients in 2006-2018 who started atorvastatin, pravastatin, simvastatin, rosuvastatin, or lovastatin post-transplant. Those who used statins pre-transplant or had the outcome of interest before transplant or statin initiation were excluded. Those who used multiple statins were censored at the initiation of the second statin. We analyzed Medicare institutional claims to ascertain various safety/effectiveness outcomes (see Table 1) and Medicare pharmacy claims to ascertain statin use. Deaths were captured from multiple sources including Social Security and CMS data. We used Cox regressions to compare mortality and the safety/effectiveness outcomes between statins, after adjusting for multiple recipient-, donor-, and transplant-related risk factors.
Results
Our cohort included 16,967 recipients; 7,885 used atorvastatin, 4,065 used pravastatin, 3,617 used simvastatin, 1,207 used rosuvastatin, and 193 used lovastatin. Compared to atorvastatin users, pravastatin users showed lower risk of all-cause mortality (aHR=0.82 [95% CI; 0.72-0.94]), cardiovascular mortality (aHR=0.73 [95% CI; 0.55-0.98]), myocardial infarction (aHR=0.79 [95% CI; 0.62-1.00]), and hemorrhagic stroke (aHR=0.57 [95% CI; 0.33-0.98]). Simvastatin users showed lower risk of all-cause mortality (aHR=0.88 [95% CI; 0.78-0.98]), cardiovascular mortality (aHR=0.75 [0.58-0.97]), and hemorrhagic stroke (aHR=0.55 [95% CI; 0.35-0.86]). Other outcomes did not differ between statins (Table 1).
Conclusion
Pravastatin and simvastatin might be preferrable over atorvastatin in kidney transplant recipients. Further research addressing other cardiovascular risk factors and statin dose is needed.
Funding
- NIDDK Support