Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study

Abstract

Background Whether there is a kidney function threshold to statin effectiveness in patients with acute myocardial infarction is poorly understood. Our study sought to help fill this gap in clinical knowledge. Methods We undertook a new-user cohort study of the effectiveness of statin therapy by level of estimated glomerular filtration rate (eGFR) in adults who were hospitalized for myocardial infarction (MI) between 2000 and 2008. Data came from the Cardiovascular Research Network. The primary clinical outcomes were one-year all-cause mortality and cardiovascular hospitalizations, with adverse outcomes of myopathy and development of diabetes mellitus. We calculated incidence rates, the number needed to treat (NNT) and used Cox proportional hazards regression with propensity score matching and adjustment to control for confounding, with testing for variation of effect by level of kidney function. Results Compared with statin non-initiators (n=5,583), statin initiators (n=5,597) had a lower propensity score-adjusted risk for death (HR, 0.79; 95% Confidence Interval [CI], 0.71, 0.88) and cardiovascular hospitalizations (HR, 0.90; 95% CI, 0.82, 1.00). We found little evidence of variation in effect by level of eGFR (p=0.86 for death; p=0.77 for cardiovascular hospitalization). Adverse outcomes were similar for statin initiators and statin non-initiators. The NNT to prevent one additional death over 1 year of follow-up ranged from 15 (95% CI 11, 28) for eGFR <30 ml/min/1.73 m2 requiring statin treatment over 2 years to prevent one additional death, to 67 (95% CI 49, 118) for patients with eGFR >90 ml/min/1.73m2. Conclusions Our findings suggest that there is potential for important public health gains by increasing the routine use of statin therapy for patients with lower levels of kidney function.

Real-world cardiovascular disease burden in patients with atherosclerotic cardiovascular disease: a comprehensive systematic literature review

“…Smith et al 30 reported an all-cause death rate of 119.3 per 1000 person-years in MI patients that initiated statins, based on data from the Cardiovascular Research Network. Two studies focused on stroke cohorts.…”

“…Incidence of CV-related mortality was reported in four studies, ranging from 1.0 to 94.5 (median: 21.1) per 1000 personyears 22,23,27,28 . Incidence of all-cause mortality was reported in eight studies, ranging from 9.7 to 486 (median: 52.6) per 1000 person-years [19][20][21][22][26][27][28][29][30] . Three studies included ASCVD patients.…”

“…Among the nine included studies reporting mortality rates, all evaluated patients on lipid-lowering therapy [20][21][22][23][26][27][28][29][30] . Incidence of CV-related mortality was reported in four studies, ranging from 1.0 to 94.5 (median: 21.1) per 1000 personyears 22,23,27,28 .…”

Effect of Different Statin Intensity in Chronic Kidney Disease Patients

“…We read with interest an article written by Smith et al 1 The authors performed a comparative effectiveness analysis of statin therapy by different levels of the estimated glomerular filtration rate (eGFR). They found relatively similar reduction in deaths and cardiovascular disease hospitalization across the range of eGFR, with higher rates in patients with lower eGFR.…”

Acute coronary syndrome and renal dysfunction

“…У пациентов после ИМ статины сохраняли эффективность при дисфункции почек, за исключением 5 стадии ХБП [78][79][80]. Расчеты показывают, что для предупреждения одной смерти в течение 2 лет принимать статины необходимо 15 пациентам с ИМ с рСКФ <30 мл/мин/1,73 м 2 , а при рСКФ >90 мл/мин/1,73 м 2уже 67 пациентам [81].…”