Association of Low-Density Lipoprotein Cholesterol Levels During Statin Treatment With Cardiovascular and Renal Outcomes in Patients With Moderate Chronic Kidney Disease

• Published in: Journal of the American Heart Association Vol. 11; no. 19; p. e027516
• Main Authors: Yen, Chieh-Li, Fan, Pei-Chun, Lee, Cheng-Chia, Chen, Jia-Jin, Kuo, George, Tu, Yi-Ran, Chu, Pao-Hsien, Hsu, Hsiang-Hao, Tian, Ya-Chung, Chang, Chih-Hsiang
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 04.10.2022; Wiley
• Subjects: cardiovascular disease; Cerebral Hemorrhage - chemically induced; Cholesterol, LDL; chronic kidney disease; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Kidney Failure, Chronic; low‐density lipoprotein cholesterol; Original Research; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; statin; stroke; Treatment Outcome; cardiovascular disease; chronic kidney disease; statin; stroke; low‐density lipoprotein cholesterol
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.122.027516

Background The benefit of low-density lipoprotein cholesterol (LDL-C) levels in chronic kidney disease populations remains unclear. This study evaluated the cardiovascular and renal outcomes in patients with stage 3 chronic kidney disease with different LDL-C levels during statin treatment. Methods and Results There were 8500 patients newly diagnosed as having stage 3 chronic kidney disease under statin treatment who were identified from the Chang Gung Research Database and divided into 3 groups according to their first LDL-C level after the index date: <70 mg/dL, 70 to 100 mg/dL, and >100 mg/dL. Inverse probability of treatment weighting was performed to balance baseline characteristics. Compared with the LDL-C ≥100 mg/dL group, the 70≤LDL-C<100 mg/dL group exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (6.8% versus 8.8%; subdistribution hazard ratio [SHR], 0.76 [95% CI, 0.64-0.91]), intracerebral hemorrhage (0.23% versus 0.51%; SHR, 0.44 [95% CI, 0.25-0.77]), and new-onset end-stage renal disease requiring chronic dialysis (7.6% versus 9.1%; SHR, 0.82 [95% CI, 0.73-0.91]). By contrast, the LDL-C <70 mg/dL group exhibited a marginally lower risk of major adverse cardiac and cerebrovascular events (7.3% versus 8.8%; SHR, 0.82 [95% CI, 0.65-1.02]) and a significantly lower risk of new-onset end-stage renal disease requiring chronic dialysis (7.1% versus 9.1%; SHR, 0.76 [95% CI, 0.67-0.85]). Conclusions Among patients with stage 3 chronic kidney disease, statin users with 70≤LDL-C<100 mg/dL and with LDL-C <70 mg/dL had similar beneficial effect in the reduction of risks of major adverse cardiac and cerebrovascular events and new-onset end-stage renal disease compared with those with LDL-C >100 mg/dL. Moreover, the 70≤LDL-C<100 mg/dL group seemed to have a lowest risk of intracerebral hemorrhage, although the incidence was low.