接受中等强度或高强度他汀类药物治疗的慢性肾脏病成年患者的动脉粥样硬化性心血管疾病事件：慢性肾功能不全队列（CRIC）研究

Atherosclerotic Cardiovascular Disease Events in Adults With CKD Taking a Moderate- or High-Intensity Statin: The Chronic Renal Insufficiency Cohort (CRIC) Study.

作者信息

Poudel Bharat, Rosenson Robert S, Bittner Vera, Gutiérrez Orlando M, Anderson Amanda H, Woodward Mark, Deo Rajat, Carson April P, Mues Katherine E, Dluzniewski Paul J, Jaar Bernard G, Lora Claudia M, Taliercio Jonathan, Muntner Paul, Colantonio Lisandro D

机构信息

Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.

Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY.

出版信息

Kidney Med. 2021 Jun 19;3(5):722-731.e1. doi: 10.1016/j.xkme.2021.04.008. eCollection 2021 Sep-Oct.

RATIONALE & OBJECTIVE: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline uses risk stratification to guide the decision to initiate nonstatin lipid-lowering medication among adults with atherosclerotic cardiovascular disease (CVD). We determined atherosclerotic CVD (ASCVD) event rates among adults with chronic kidney disease (CKD) taking statin therapy within 2018 AHA/ACC cholesterol guideline risk categories.

STUDY DESIGN

Observational cohort study.

SETTING & PARTICIPANTS: Adults with CKD not on dialysis in the Chronic Renal Insufficiency Cohort (CRIC) study who were taking a moderate/high-intensity statin 1 year after enrollment (baseline for the current analysis, n = 1,753).

EXPOSURE

2018 AHA/ACC cholesterol guideline risk categories: without a history of ASCVD, a history of 1 major ASCVD event and multiple high-risk conditions, and a history of ≥2 major ASCVD events.

OUTCOME

Adjudicated ASCVD events after the year 1 study visit.

ANALYTICAL APPROACH

We calculated age-sex standardized rates for ASCVD events and age-sex adjusted hazard ratios for ASCVD events accounting for the competing risk of death.

RESULTS

There were 394 ASCVD events over a median follow-up period of 8 years. The ASCVD event rates (with 95% CI) per 1,000 person-years among participants without a history of ASCVD, with a history of 1 major ASCVD event and multiple high-risk conditions, and with a history of ≥2 major ASCVD events were 21.7 (18.4-25.1), 45.0 (37.8-52.3), and 73.3 (53.3-93.4), respectively. Compared with participants without a history of ASCVD, the HR (95% CI) rates for ASCVD events among those with a history of 1 major ASCVD event and multiple high-risk conditions, and with a history of ≥2 major ASCVD events were 1.89 (1.52-2.36) and 2.50 (1.85-3.39), respectively.

LIMITATIONS

Data on whether participants were taking a maximally tolerated statin dosage were unavailable.

CONCLUSIONS

The 2018 AHA/ACC cholesterol guideline identifies adults with CKD who have very high ASCVD risk despite taking a moderate/high-intensity statin.

原理与目的

2018年美国心脏协会/美国心脏病学会（AHA/ACC）胆固醇指南采用风险分层来指导在患有动脉粥样硬化性心血管疾病（CVD）的成年人中启动非他汀类降脂药物治疗的决策。我们确定了在2018年AHA/ACC胆固醇指南风险类别中接受他汀类药物治疗的慢性肾脏病（CKD）成年人的动脉粥样硬化性CVD（ASCVD）事件发生率。

研究设计

观察性队列研究。

设置与参与者

慢性肾功能不全队列（CRIC）研究中未接受透析的CKD成年人，在入组1年后服用中等强度/高强度他汀类药物（当前分析的基线，n = 1753）。

暴露因素

2018年AHA/ACC胆固醇指南风险类别：无ASCVD病史、有1次主要ASCVD事件和多种高危情况病史、有≥2次主要ASCVD事件病史。

结局

在第1年研究访视后的经判定的ASCVD事件。

分析方法

我们计算了ASCVD事件的年龄-性别标准化发生率以及考虑死亡竞争风险的ASCVD事件的年龄-性别调整风险比。

结果

在中位随访期8年期间，有394例ASCVD事件。无ASCVD病史、有1次主要ASCVD事件和多种高危情况病史、有≥2次主要ASCVD事件病史的参与者每1000人年的ASCVD事件发生率（95%CI）分别为21.7（18.4 - 25.1）、45.0（37.8 - 52.3）和73.3（53.3 - 93.4）。与无ASCVD病史的参与者相比，有1次主要ASCVD事件和多种高危情况病史、有≥2次主要ASCVD事件病史的参与者发生ASCVD事件的HR（95%CI）分别为1.89（1.52 - 2.36）和2.50（1.85 - 3.39）。

局限性

无法获得参与者是否服用最大耐受他汀剂量的数据。

结论

2018年AHA/ACC胆固醇指南确定了患有CKD的成年人，尽管服用了中等强度/高强度他汀类药物，但仍有非常高的ASCVD风险。