Trends and outcome of statin therapy in dialysis patients with atherosclerotic cardiovascular diseases: A population-based cohort study

• Published in: PloS one Vol. 18; no. 6; p. e0286670
• Main Authors: Lee, Myunhee, Hong, Yu Ah, Myong, Jun-Pyo, Lee, Kyusup, Park, Mahn-Won, Kim, Dae-Won
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.06.2023; Public Library of Science (PLoS)
• Subjects: Analysis; Arteriosclerosis; Atherosclerosis; Biology and Life Sciences; Cardiovascular agents; Cardiovascular disease; Cardiovascular diseases; Care and treatment; Cohort analysis; Confidence intervals; Diagnosis; Dialysis; Health aspects; Health hazards; Health insurance; Health risks; Medicine and Health Sciences; Mortality; National health insurance; Patient outcomes; Peritoneal dialysis; Population studies; Population-based studies; Prevention; Regression analysis; Statins; Statistical analysis; Therapy; Trends; South Korea
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0286670

Although statins are an effective strategy for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the general population, the benefits for dialysis patients are controversial. We sought to assess trends of statin use and evaluate outcomes of statin therapy in dialysis patients with different types of ASCVD. This nationwide retrospective population-based cohort study using data from the Korean National Health Insurance Service included adult patients (aged ≥ 18 years) undergoing chronic dialysis who had an initial ASCVD event in the time period of 2013 to 2018. Annual trends of statin use according to age, sex, and ASCVD types were analyzed. The association between 1-year mortality and statin use was examined using multivariable Cox proportional hazards regression analyses. Among 17,242 subjects, 9,611(55.7%) patients were statin users. The overall prevalence of statin use increased from 52.9% in 2013 to 57.7% in 2018; the majority (77%) of dialysis patients were prescribed moderate-intensity statins. The proportions of low- or moderate-intensity statin use were similar, but high-intensity statin use increased from 5.7% in 2013 to 10.5% in 2018. The use of the statin/ezetimibe combination has gradually increased since 2016. Statin use was independently associated with the reduced 1-year all-cause mortality after adjusting for confounding factors (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.96, P = 0.004). The prevalence of statin prescriptions in dialysis patients after ASCVD event increased from 2013 to 2018. Most patients received moderate-intensity statin. However, high-intensity statin and statin/ezetimibe combination therapy has remarkably increased. Statin use was associated with decreased 1-year all-cause mortality in dialysis patients with ASCVD.