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

Abstract

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.

• Authors: Bharat Poudel, Robert S Rosenson, Vera Bittner, Orlando M Gutiérrez, Amanda H Anderson, Mark Woodward, Rajat Deo, April P Carson, Katherine E Mues, Paul J Dluzniewski, Bernard G Jaar, Claudia M Lora, Jonathan Taliercio, Paul Muntner, Lisandro D Colantonio, Chronic Renal Insufficiency Cohort (CRIC) Study Investigators
• Journal: Kidney medicine (Kidney Med) 2021 Sep-Oct Vol. 3 Issue 5 Pg. 722-731.e1 ISSN: 2590-0595 [Electronic] United States
• PMID: 34693254 (Publication Type: Journal Article)
• Copyright: © 2021 The Authors.