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A scoring system for predicting individual treatment effects of statins in type 2 diabetes patients on haemodialysis

Bernd Genser1,2, Christoph Wanner1, Winfried März3,4,5

  • 1Division of Nephrology, Department of Medicine, University of Würzburg, Germany.

European Journal of Preventive Cardiology
|July 23, 2021
PubMed

Insights

Statins may harm some hemodialysis patients with diabetes, while benefiting others. A new score predicts individual responses, aiding personalized cardiovascular risk management in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacogenomics

Background:

  • Patients undergoing hemodialysis have a high risk of cardiovascular disease.
  • Statins are beneficial for cardiovascular risk reduction in chronic kidney disease but not in hemodialysis patients.
  • Previous analyses identified patient-specific markers for heterogeneous statin effects in hemodialysis patients.

Purpose of the Study:

  • To develop and validate a predictive score for individual statin treatment effects in hemodialysis patients.
  • To identify subgroups of patients who may benefit from or be harmed by statin therapy.

Main Methods:

  • Utilized data from the 4D study (1255 hemodialysis patients with type 2 diabetes randomized to atorvastatin or placebo).
  • Developed two scores based on 23 and 17 predictive markers, respectively.
  • Stratified patients into groups based on the predictive score to analyze differential treatment effects.

Main Results:

  • Score 1 identified patient subgroups with differential statin effects: harm (score <26), neutral effect (26-31), and benefit (score >31).
  • The benefit group (score >31) showed a 0.43 hazard ratio for cardiovascular events and reduced all-cause mortality.
  • Score 2, using clinically accessible markers, yielded similar but less pronounced stratification.

Conclusions:

  • Statin efficacy in hemodialysis patients is predictable using markers related to cholesterol metabolism, atherosclerosis, protein energy wasting, and competing risks.
  • The developed score can aid in clinical risk stratification, identifying patients who benefit from statins and those who may experience harm.
  • Personalized statin therapy based on this score could optimize cardiovascular risk management in hemodialysis patients.
Abstract

Keywords:
Cardiovascular riskatherosclerosishaemodialysispersonalised lipid managementprediction scorestatin

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