Can Statins Reduce Mortality Risk Among Older Adults With Moderate Chronic Kidney Disease?

In a cohort study using a trial emulation design for statin initiation among veterans with stage 3 to 4 chronic kidney disease (CKD), researchers found that statin use in US veterans older than 65 years of age with moderate CKD and no history of atherosclerotic cardiovascular disease (ASCVD) was associated with a lower risk of all-cause mortality.

Current Kidney Disease Improving Global Outcomes guidelines recommend older patients with moderate CKD initiate statins due to the population’s heightened risk of ASCVD. The guidelines do not differentiate between primary and secondary prevention, though, and prior research has had conflicting results on the efficacy of statin use in primary prevention of mortality for patients with non-dialysis CKD.

To better understand how statin use can impact all-cause mortality as well as major adverse cardiovascular events (MACE), the researchers followed 14,828 veterans newly diagnosed with moderate CKD, using nested trials with a propensity weighting approach. Analysis of linked data from the Medicare, Medicaid, and the Veteran Affairs (VA) Healthcare System was conducted from July 2021 to October 2023.

The study included veterans in the VA who were newly diagnosed with moderate CKD between 2005 to 2015, with follow-up through December 31, 2017. Participants were also older than 65 years, had been diagnosed with CKD within the last 5 years, had no history of statin use or ASCVD, and had at least one clinical visit in the year prior to trial baseline. 

The primary outcome was all-cause mortality, while the secondary outcome was measuring patients’ time to MACE, such as myocardial infarction, transient ischemic attack, stroke, revascularization, or death.

The researchers separated participants into two groups: those who initiated statins, and those who did not. They observed that statin initiation was connected to a lower risk of all-cause mortality, including a 9% lower risk of death for those taking statins compared to those who were not (hazard ratio [HR], 0.91, 95% CI, 0.85 to 0.97). The reduction in MACE was not statistically significant, however, suggesting little difference in cardiovascular outcomes between the groups (HR, 0.96, 95% CI, 0.91 to 1.02).

The authors noted that more rigorous randomized clinical trials are needed to confirm these findings.

“In this target trial emulation of statin initiation in US veterans older than 65 years with CKD stages 3 to 4 and no prior ASCVD, statin initiation was significantly associated with a lower risk of all-cause mortality but not MACE,” the authors concluded.

Reference

Barayev O, Hawley CE, Wellman H, et al. Statins, mortality, and major adverse cardiovascular events among US veterans with chronic kidney disease. JAMA Netw Open. 2023;6(12). doi:10.1001/jamanetworkopen.2023.46373