Risks for nonfatal cardiovascular events and cardiovascular death were lower with statins.
Cardiovascular disease is the leading cause of death among patients with chronic kidney disease (CKD). In the general population and in patients with established cardiovascular disease, statins lower risks for nonfatal cardiovascular events, cardiovascular deaths, and all-cause mortality. Do statins have similar benefits in patients with CKD?
An international team of investigators conducted a meta-analysis of 50 randomized trials in which any statin was compared with placebo, no treatment, or other statins; the trials involved more than 30,000 adults with CKD (defined as patients who had elevated serum creatinine levels or glomerular filtration rates, who were undergoing maintenance dialysis, or who had undergone kidney transplantation). Most patients had established cardiovascular disease. Compared with placebo, statins significantly lowered total and LDL cholesterol and proteinuria levels but did not improve creatinine clearance rates. Statins also significantly lowered risks for nonfatal cardiovascular events (by 22%) and cardiovascular death (by 19%) but not all-cause mortality. Treatment effects did not vary by CKD stage. Notably, the side-effect profile of statins was similar to that of placebo.
Comment: Most patients included in this meta-analysis had established cardiovascular disease. Hence, the findings mainly affirm that statins are effective in lowering risks for nonfatal cardiovascular events and cardiovascular death in CKD patients with established cardiovascular disease (secondary prevention). As noted by the authors, whether statins are effective in CKD patients without established cardiovascular disease (primary prevention) will be determined by ongoing clinical trials.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine March 25, 2008
Strippoli GFM et al. Effects of statins in patients with chronic kidney disease: Meta-analysis and meta-regression of randomised controlled trials. BMJ 2008 Mar 22; 336:645.