Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis

Hou, Weimin; Lv, Jicheng; Perkovic, Vlado; Yang, Lihong; Zhao, Na; Jardine, Meg; Cass, Alan; Zhang, Hong; Wang, Haiyan

doi:10.1093/eurheartj/eht065

Cited by 157 publications

(96 citation statements)

References 40 publications

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“…However, a recent clinical trial showed clearly the benefit of intensive LDL-lowering therapy in patients with chronic kidney disease (Baigent et al 2011). The value of statin therapy in patients with chronic kidney disease is supported by two recent meta-analyses (Barylski et al 2013;Hou et al 2013). Whether statins are useful in patients on hemodialysis is uncertain.…”

Section: Management Of Non-lipid Risk Factors In Primary Preventionmentioning

confidence: 99%

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

Grundy

2013

Journal of Clinical Lipidology

147

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Section: Management Of Non-lipid Risk Factors In Primary Preventionmentioning

confidence: 99%

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

Grundy

2013

Journal of Clinical Lipidology

147

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“…[1][2][3] In many populations, hepatic hydroxymethyl glutaryl-CoA reductase inhibitors (statins) are important therapies for both primary and secondary cardiovascular risk mitigation; however, for individuals with reduced eGFR, the optimal lipid-lowering therapies for reducing cardiovascular risk remain unclear. [4][5][6][7][8][9][10][11][12] A meta-analysis of 14 statin trials assessing the effects of LDL cholesterol reduction in individuals with impaired kidney function found that the risk of first major cardiovascular event was reduced proportional to the reduction in LDL cholesterol, with a trend toward decreased relative benefits as eGFR declined. 13 Among individuals with CKD, the strongest single trial supporting cardiovascular risk-lowering benefit for statin therapies was shown with ezetimibe plus simvastatin compared with placebo in the Study of Heart and Renal Protection (SHARP).…”

mentioning

confidence: 99%

Benefit of Ezetimibe Added to Simvastatin in Reduced Kidney Function

Stanifer

Charytan

White

et al. 2017

JASN

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Efficacy of statin-based therapies in reducing cardiovascular mortality in individuals with CKD seems to diminish as eGFR declines. The strongest evidence supporting the cardiovascular benefit of statins in individuals with CKD was shown with ezetimibe plus simvastatin versus placebo. However, whether combination therapy or statin alone resulted in cardiovascular benefit is uncertain. Therefore, we estimated GFR in 18,015 individuals from the IMPROVE-IT (ezetimibe plus simvastatin versus simvastatin alone in individuals with cardiovascular disease and creatinine clearance .30 ml/min) and examined post hoc the relationship of eGFR with end points across treatment arms. For the primary end point of cardiovascular death, major coronary event, or nonfatal stroke, the relative risk reduction of combination therapy compared with monotherapy differed by eGFR (P=0.04). The difference in treatment effect was observed at eGFR#75 ml/min per 1.

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“…Despite these potential mechanisms linking atherosclerosis to kidney disease progression, randomized controlled trials have yielded inconclusive results regarding whether statin can prevent kidney disease progression (34)(35)(36). However, we need to keep in mind that most previous statin trials were designed to assess the prevention of cardiovascular outcomes and underpowered to evaluate renoprotection (34)(35)(36).…”

Section: Discussionmentioning

confidence: 99%

“…However, we need to keep in mind that most previous statin trials were designed to assess the prevention of cardiovascular outcomes and underpowered to evaluate renoprotection (34)(35)(36). Given that the significant association with ESRD risk was observed primarily in the top quartile of carotid IMT, it may be that statin therapy is particularly effective in the prevention of kidney disease progression among people with higher burdens of subclinical atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

Carotid Intima-Media Thickness and Incident ESRD: The Atherosclerosis Risk in Communities (ARIC) Study

Pang

Sang

Ballew

et al. 2016

CJASN

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Background and objectives Carotid intima-media thickness has been reported to predict kidney function decline. However, whether carotid intima-media thickness is associated with a hard kidney end point, ESRD, has not been investigated.Design, setting, participants, & measurements We studied 13,197 Atherosclerosis Risk in Communities participants at visit 1 (1987)(1988)(1989) without history of cardiovascular disease, including coronary heart disease, stroke, and heart failure, at baseline and assessed whether carotid intima-media thickness measured by B-mode ultrasound is associated with ESRD risk using Cox proportional hazards models. Regarding carotid intimamedia thickness parameters, we investigated the mean and maximum values of overall and segment-specific (common, bifurcation, and internal carotid arteries) measurements.Results Mean age was 54.0 (SD=5.7) years old, and there were 3373 (25.6%) blacks and 7370 (55.8%) women. During a median follow-up of 22.7 years, 433 participants developed ESRD (1.4/1000 person-years). After adjusting for shared risk factors for atherosclerosis and kidney disease, including baseline kidney function, carotid intima-media thickness was significantly associated with ESRD risk (hazard ratio [HR] between quartiles 4 and 1, 1.46; 95% confidence interval [95% CI], 1.02 to 2.08 for overall mean intima-media thickness and HR between quartiles 4 and 1, 1.75; 95% CI, 1.24 to 2.48 for overall maximum intima-media thickness). The associations were largely consistent in demographic and clinical subgroups. When we explored segment-specific intima-media thicknesses, the associations with ESRD were most robust for bifurcation carotid (e.g., adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.49; 95% CI, 1.04 to 2.13 for bifurcation; adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 1.36; 95% CI, 0.94 to 1.97 for common; and adjusted HR between quartiles 4 and 1 of mean intima-media thickness, 0.93; 95% CI, 0.67 to 1.29 for internal).Conclusions Carotid intima-media thickness was independently associated with incident ESRD in the general population, suggesting the shared etiology of atherosclerosis and ESRD.

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Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis

Abstract: Statin therapy reduces the risk of major cardiovascular events in patients with chronic kidney disease including those receiving dialysis.

Cited by 157 publications

References 40 publications

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

Benefit of Ezetimibe Added to Simvastatin in Reduced Kidney Function

Carotid Intima-Media Thickness and Incident ESRD: The Atherosclerosis Risk in Communities (ARIC) Study

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