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Association between statin treatment and outcome in relation to renal function in survivors of myocardial infarction

Karolina Szummer1, Pia Lundman, Stefan H Jacobson

  • 1Department of Medicine, Section of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. karolina.szummer@karolinska.se

Kidney International
|January 14, 2011
PubMed

Insights

Statin therapy after myocardial infarction (MI) improves survival in patients with mild-to-severe kidney disease. However, this benefit is reduced in patients with end-stage renal failure (stage 5).

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Statins are recommended for all patients post-myocardial infarction (MI).
  • The efficacy of statins in patients with renal disease requires further investigation.
  • Understanding statin use and outcomes in chronic kidney disease (CKD) is crucial.

Purpose of the Study:

  • To evaluate the utilization and effectiveness of statin therapy in myocardial infarction survivors with varying stages of renal impairment.
  • To assess the impact of statin prescription at discharge on 1-year survival in patients with kidney disease.

Main Methods:

  • Analysis of 42,814 myocardial infarction survivors from the SWEDEHEART registry.
  • Classification of patients into five stages of kidney disease based on estimated glomerular filtration rate (eGFR) using the MDRD formula.
  • Cox regression analysis adjusted for propensity scores to assess 1-year survival in relation to statin prescription.

Main Results:

  • Statin prescription at discharge decreased significantly with worsening renal impairment (81% in eGFR stage 1 to 31% in eGFR stage 5).
  • Statin use was associated with a 37% reduction in the overall risk of death (hazard ratio 0.63) after adjustment.
  • A significant interaction between statin therapy and renal function stage was observed, with improved survival in stages 2-4 but attenuated effect in stage 5.

Conclusions:

  • Statin therapy at discharge following myocardial infarction is associated with improved 1-year survival in patients with mild-to-severe renal insufficiency (eGFR stages 2-4).
  • The survival benefit of statins appears diminished in patients with end-stage renal disease (eGFR stage 5).
  • These findings highlight the importance of considering renal function when prescribing statins post-MI.

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