Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cardiology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
Atherosclerosis. 2024 Dec;399:119042. doi: 10.1016/j.atherosclerosis.2024.119042. Epub 2024 Oct 31.
Different from other high cardiovascular (CV) risks populations, the evidence supporting the CV protective effect of LDL-C reduction with statins in chronic kidney disease (CKD) patients is comparatively scarce. This study is aimed to investigate the role of maintaining lower LDL-C level in advanced CKD patients.
By using Chang Gung Research Database, on the basis of Taiwan's largest healthcare group, a total of 5367 adult patients newly-diagnosed with stage 4 CKD and receiving statin were extracted and further categorized into three groups based on their LDL-C levels: <70 mg/dL, 70-100 mg/dL, and ≥100 mg/dL. The main outcome is major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiovascular death, myocardial infarction, and stroke. The inverse probability of treatment weighting was performed to achieve balance of baseline characteristics.
At 5-year follow-up, the LDL-C < 70 mg/dL group exhibited significantly lower risks of MACCEs (14.3 % vs. 18.7 %, hazard ratio [HR]: 0.77, 95 % CI: 0.69-0.86), cardiovascular death (7.1 % vs. 9.7 %, subdistribution HR [SHR]: 0.75, 95 % CI: 0.65-0.88), ischemic stroke (4.1 % vs. 5.4 %, [SHR]: 0.65, 95 % CI: 0.54-0.79), and new-onset end-stage renal disease requiring chronic dialysis (25.6 % vs. 29.4 %, SHR: 0.87, 95 % CI: 0.80-0.91) compared to LDL-C > 100 mg/dL group. In contrast, the group with LDL-C levels between 70 and 100 did not significantly differ from the group with LDL-C > 100 mg/dL in study outcomes.
Maintaining LDL-C lower than 70 mg/dL may be beneficial for cardiovascular protection in advanced CKD patients and a lower LDL-C treatment target may be required as CKD progression.
与其他心血管（CV）高危人群不同，他汀类药物降低 LDL-C 对慢性肾脏病（CKD）患者的 CV 保护作用的证据相对较少。本研究旨在探讨维持晚期 CKD 患者较低 LDL-C 水平的作用。
利用长庚研究数据库，基于台湾最大的医疗保健集团，共提取了 5367 名新诊断为 4 期 CKD 并接受他汀类药物治疗的成年患者，并根据 LDL-C 水平将其分为三组：<70mg/dL、70-100mg/dL 和≥100mg/dL。主要结局是主要不良心脑血管事件（MACCEs），包括心血管死亡、心肌梗死和中风的复合结局。采用逆概率治疗加权法实现基线特征的平衡。
在 5 年随访期间，LDL-C<70mg/dL 组的 MACCEs 风险显著降低（14.3%比 18.7%，风险比[HR]：0.77，95%CI：0.69-0.86）、心血管死亡（7.1%比 9.7%，亚分布 HR[SHR]：0.75，95%CI：0.65-0.88）、缺血性中风（4.1%比 5.4%，SHR：0.65，95%CI：0.54-0.79）和新诊断的需要慢性透析的终末期肾病（25.6%比 29.4%，SHR：0.87，95%CI：0.80-0.91）明显低于 LDL-C>100mg/dL 组。相比之下，LDL-C 水平在 70-100mg/dL 之间的组与 LDL-C>100mg/dL 组的研究结局没有显著差异。
维持 LDL-C 低于 70mg/dL 可能有益于晚期 CKD 患者的心血管保护，随着 CKD 的进展，可能需要更低的 LDL-C 治疗目标。
