Statin use may not meaningfully reduce CV events in patients on dialysis
Click Here to Manage Email Alerts
Among patients with established atherosclerotic heart disease on dialysis, the effect of statins on CV events was modest at best, according to a study published in the American Heart Journal.
“In patients with established atherosclerotic heart disease (ASHD), statins significantly reduce the risk of atherosclerotic CV events,” Jay S. Shavadia, MD, assistant professor of cardiology at the University of Saskatchewan in Canada and a member in the Duke Clinical Research Institute, and colleagues wrote. “In contrast, three well-conducted randomized controlled trials of statin therapy in patients with end-stage kidney disease (ESKD) on maintenance dialysis have not identified a CV benefit of statins in this population. ... Therefore, the role of statins in patients on dialysis with ASHD remains a major gap in the field.”
In this observational comparative study, researchers identified 197,716 adult patients with ASHD who initiated dialysis and matched statin users to statin nonusers (n= 46,186 matched pairs) using propensity scoring. The researchers used Cox models to assess association of statin use with fatal or nonfatal MI, stroke and all-cause mortality.
During a median of 662 days, statin users had a similar risk for fatal or nonfatal MI or stroke (HR = 1; 95% CI, 0.97-1.02) and a slightly lower risk for all-cause mortality (HR = 0.96; 95% CI, 0.94-0.98). Statin use was also associated with a modest lower risk for all-cause mortality/nonfatal MI/stroke during the first 2 years (HR = 0.9; 95% CI, 0.88-0.91), but that did not persist thereafter (HR = 0.98; 95% CI, 0.96-1.01).
“In patients with ESKD and ASHD incident to dialysis, statin users and nonusers experienced similar risk of a fatal or nonfatal MI or stroke,” Shavadia and colleagues wrote. “While modest associations with all-cause mortality are observed, the primary results of this nonrandomized analysis provide further evidence to reconsider the role of statins in the secondary prevention of atherosclerotic CV events.”
Collapse
Click Here to Manage Email Alerts