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Effect of statins on cardiovascular complications in chronic kidney disease patients: A network meta-analysis
Seun Deuk Hwang1, Kipyo Kim1, Yoon Ji Kim2
1Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon.
Insights
Pravastatin 40mg significantly reduced patient mortality in chronic kidney disease (CKD) patients. This statin also ranked highly for reducing cardiac events, aiding physician treatment decisions.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Cardiovascular disease (CVD) risk is elevated in patients with chronic kidney disease (CKD).
- Understanding the impact of statins on CVD events and mortality in CKD is crucial.
Purpose of the Study:
- To investigate the comparative effectiveness of various statins in reducing mortality and cardiac events in CKD patients.
- To rank statins based on their efficacy in managing cardiovascular outcomes in CKD.
Main Methods:
- A network meta-analysis of randomized controlled trials (RCTs) published from 1970 to February 2019 was conducted.
- Included were 19 studies with 45,863 adult patients, analyzing statins like atorvastatin, rosuvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin.
- Bayesian models and the GRADE approach were used to assess outcomes including cardiac events, cardiac mortality, and all-cause mortality.
Main Results:
- Pravastatin 40mg demonstrated a significant reduction in patient mortality compared to placebo (OR 0.66).
- Atorvastatin 80mg, fluvastatin 40mg, lovastatin 20mg, pravastatin 40mg, and simvastatin 40mg effectively reduced cardiac events.
- Pravastatin ranked highest for reducing all-cause mortality, while lovastatin, fluvastatin, and pravastatin showed strong performance for cardiac events.
Conclusions:
- Pravastatin 40mg is a highly effective statin for reducing all-cause mortality in CKD patients.
- The findings support pravastatin as a beneficial treatment option for managing cardiovascular risk in individuals with CKD.
Background:
The rates of cardiovascular mortality and morbidity are increased in advanced chronic kidney disease (CKD). Mild to moderate CKD is associated with an increase in cardiovascular events. This study aims to investigate the effects of statins on patient mortality and cardiac events.
Study Appraisal And Synthesis Methods:
Studies on statins (atorvastatin, rosuvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, and simvastatin + ezetimibe) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2019 were analyzed. Inclusion criteria were randomized control trials and adult patients (>18 years old). Reviews, observational studies, and clinical trials that did not clearly define outcomes or that did not have thrombosis as an outcome were excluded. We performed direct and indirect network meta-analysis using Bayesian models and ranked different statins using generation mixed treatment comparison (GeMTC) and Stata version 13. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. The outcomes were cardiac events, cardiac mortality, and all-cause mortality.
Results:
Nineteen studies (45,863 patients) were included. Compared with placebos, pravastatin 40 mg group showed a significantly lower patient mortality (odds ratio 0.66 [95% credible interval, 0.46-0.91]).Atorvastatin 80 mg, fluvastatin 40 mg, lovastatin 20 mg, pravastatin 40 mg, and simvastatin 40 mg showed significant results in reducing cardiac events.In rank probability, pravastatin showed the best effect at all-cause mortality rate. Lovastatin, fluvastatin, and pravastatin showed good effects in the 1st, 2nd, and 3rd ranks in cardiac events.
Conclusions And Implications Of Key Findings:
Pravastatin 40 mg demonstrated the best effect on all-cause mortality, and was observed to be effective with high ranking in cardiac events. We anticipate that the data of this study will assist physicians in making informed decisions when selecting statins, such as pravastatin, as a treatment option for CKD patients.
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