Although statin therapy is essential for secondary cardiovascular prevention, the
therapeutic effect of statins on cardiovascular outcomes in patients with advanced
chronic kidney disease (CKD) after coronary revascularization has not been fully elucidated.
In the CREDO-Kyoto Registry Cohort-2, 14,706 patients who underwent first coronary
revascularization were divided into 4 strata based on estimated glomerular filtration
rate (eGFR) or status of hemodialysis (HD). Patients in each stratum were further
divided into 2 groups based on statin therapy at discharge: non-CKD stratum (eGFR
≥60 ml/min/1.73 m2), 8,959 patients (statin, n = 4,747; no statin, n = 4,212); mild CKD stratum (eGFR
≥30 to <60 ml/min/1.73 m2), 4,567 patients (statin, n = 2,135; no statin, n = 2,432); severe CKD stratum (eGFR
<30 ml/min/1.73 m2), 608 patients (statin, n = 229; no statin, n = 379); and HD stratum, 572 patients
(statin, n = 117; no statin, n = 455). Median follow-up duration was 956 days (interquartile
range 699 to 1,245). Adjusted risk for major adverse cardiovascular events (MACEs;
composite of cardiovascular death, myocardial infarction, or stoke) was significantly
lower in the statin group than in the no-statin group in the non-CKD (hazard ratio
0.8, 95% confidence interval 0.68 to 0.95, p = 0.01) and mild CKD (hazard ratio 0.69,
95% confidence interval 0.56 to 0.84, p = 0.0002) strata. However, a significant association
of statin therapy and lower risk for MACEs was not seen in the severe CKD (hazard
ratio 0.91, 95% confidence interval 0.6 to 1.38, p = 0.65) and HD (hazard ratio 1.04,
95% confidence interval 0.64 to 1.69, p = 0.87) strata. In conclusion, statin therapy
was associated with significantly lower risk for MACEs in patients with non-CKD and
mild CKD undergoing coronary revascularization. However, therapeutic benefits of statins
were not apparent in patients with severe CKD and HD.
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Article info
Publication history
Published online: August 30, 2012
Accepted:
July 27,
2012
Received in revised form:
July 27,
2012
Received:
June 18,
2012
Footnotes
This study was supported by the Pharmaceuticals and Medical Devices Agency, Tokyo, Japan.
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
