Effect of Statin Therapy on Cardiovascular and Renal Outcomes in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Study Questions:

Does statin therapy affect major clinical outcomes among patients with chronic kidney disease (CKD)?

Methods:

MEDLINE, Embase, and the Cochrane Library were searched for trials published between 1970 and November 2011. These data were extracted either from studies conducted solely in people with kidney disease, or from subsets of other trials where data on the CKD population could be obtained. Only trials that were prospective, randomized, controlled trials assessing the effects of statins on cardiovascular outcomes were included. Major cardiovascular events included fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, revascularization procedures, cardiovascular death, and heart failure (or comparable definitions used by individual authors), cardiovascular mortality, all-cause death, new-onset cancer, and other drug-related adverse events. Summary estimates of relative risk (RR) reductions were calculated with a random-effects model.

Results:

A total of 2,310 articles were initially identified, of which 134 were reviewed in full text. Of these, 31 trials were included, which included data from 48,429 patients with CKD, and 6,690 major cardiovascular disease events and 6,653 deaths. Study follow-up duration ranged from 6 months to 4.9 years. Statin therapy was associated with a 23% RR reduction in major cardiovascular events (p < 0.001), and an 18% RR reduction in coronary events. A 9% RR reduction in cardiovascular or all-cause deaths was also noted. No significant effect on stroke was observed. Adverse events (AE) were not significantly increased by statins; these included hepatic AEs (RR, 1.13; 95% confidence interval [CI], 0.92-1.39) and muscular disorder AEs (RR, 1.02; 95% CI, 0.95-1.09). Subgroup analysis demonstrated that the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (p < 0.001), but that the absolute risk reductions were comparable.

Conclusions:

The investigators concluded that statin therapy was associated with a reduction in the risk of major cardiovascular events among patients with CKD including those receiving dialysis.

Perspective:

These data suggest benefits to statin therapy among patients with CKD. Given the increased risk for cardiovascular disease events among patients with renal disease, aggressive prevention is warranted.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: Cause of Death, Renal Dialysis, Risk, Myocardial Infarction, Stroke, Renal Insufficiency, Neoplasms, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Heart Failure, Cardiovascular Diseases, MEDLINE


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