Abstract: SA-PO0391
Comparative Risk of Major Adverse Cardiovascular Events in Patients with CKD Receiving Triglyceride-Targeting Lipid-Lowering Therapies vs. Statins
Session Information
- CKM: Clinical - Epidemiology and Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Naim, Mohammad Abdullah Al Zubair, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Streja, Elani, University of California Irvine, Irvine, California, United States
- Davis, Robert L., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center, Torrance, California, United States
- Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
In patients with chronic kidney disease (CKD), atherogenic lipid profiles, characterized by hypertriglyceridemia and impaired high-density lipoprotein cholesterol (HDL-C) metabolism, contribute to adverse cardiovascular disease (CVD) outcomes. Since evidence on the CVD outcomes of triglyceride (TG)-targeting lipid-lowering therapies (LLTs), such as fibrates and niacin, remains limited, kidney disease guidelines recommend further investigation.
Methods
We designed this retrospective cohort study using a target trial emulation framework and leveraged data from a nationwide cohort of 3,562,882 US Veterans with normal kidney function enrolled between October 2004 and September 2006. We identified 46,904 incident CKD patients initiating de novo fibrate (n=2,495), niacin (n=1,362), or statin (n=43,047) therapy using prescription data. We used multivariable adjusted Cox proportional hazards models to compare the associations of fibrate and niacin vs. statin use with major adverse cardiovascular events [MACE] (composite of acute myocardial infarction, ischemic stroke, congestive heart failure, or all-cause death) during follow-up of up to 10 years.
Results
Of the 46,904 patients in the analytical cohort, 16,191 (event rate, 79.2 [95% CI: 78.0, 80.4] per 1000 person years) experienced MACE after a median follow-up of 3.70 years. The risk of MACE was 7% lower and significantly different (Hazard Ratio [HR], 0.93 [95% CI, 0.86, 0.99]; p=0.03) in de novo fibrate users compared to statin users. Niacin users, however, did not experience a significant difference in MACE risk, compared with statin initiators (Table).
Conclusion
In this large nationwide cohort of patients with CKD, de novo fibrate use was associated with a lower risk of MACE than de novo statin use. Niacin use, on the other hand, was not associated with a significantly different risk compared to statin use. Randomized controlled trials are needed to confirm our findings.
Acknowledgment
This study was supported by grant I01HX002680 to Dr. Kovesdy and is the result of work supported with resources and the use of facilities at the Memphis and the Long Beach VA Medical Center. Support for VA/CMS data is provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, VA Information Resource
Center.
Funding
- Veterans Affairs Support