Long-Term Benefits and Safety of Statins in Patients with Kidney Failure: A Target Trial Emulation Study.

KEY POINTS

Patients with kidney failure are at a higher risk of cardiovascular diseases, but the evidence for statin therapy remains inconclusive. The long-term benefits and risks of statin therapy in patients with kidney failure were analyzed using public electronic health records in Hong Kong. Statin therapy was associated with a lower risk of major cardiovascular diseases and all-cause mortality without a higher risk of major adverse events.

BACKGROUND

Patients with kidney failure are at elevated risk of cardiovascular diseases. Although statins are commonly used to mitigate cardiovascular risk among the population with high risk, the evidence for initiating statin therapy among patients with kidney failure remains inconclusive. This study aimed to investigate the long-term benefits and risks associated with statin therapy in patients with kidney failure.

METHODS

Using territory-wide public electronic health records in Hong Kong, 3019 statin-eligible individuals with kidney failure and elevated LDL cholesterol ≥100 mg/dl from January 2008 to December 2015 were included for analysis. The framework of target trial emulation was adopted to investigate the risk of the major cardiovascular diseases (., a composite of myocardial infarction, heart failure, and stroke), all-cause mortality, and major adverse events (., myopathies and liver dysfunction) between statin initiators and statin noninitiators. The pooled logistic model was used to obtain the hazard ratio for the outcomes of interest in both intention-to-treat (ITT) analysis and per-protocol (PP) analysis.

RESULTS

Significant risk reduction associated with statin therapy (hazard ratio [95% confidence interval]) was observed for major cardiovascular diseases (ITT: 0.78 [0.62 to 0.98]; PP: 0.66 [0.50 to 0.87]) and all-cause mortality (ITT: 0.80 [0.68 to 0.95]; PP: 0.60 [0.48 to 0.76]). The standardized 5- and 10-year absolute risk reduction in PP analysis was 7% (3% to 11%) and 11% (4% to 18%), respectively. No significant risks for the major adverse events were observed.

CONCLUSIONS

Statin therapy was associated with lower risks of cardiovascular diseases and all-cause mortality in patients with kidney failure without a higher risk of major adverse events.