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The role of maintaining lower LDL-C level during statin treatment for advanced CKD patients
Chieh-Li Yen1, Pei-Chun Fan1, Cheng-Chia Lee1
1Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Insights
Maintaining low LDL-C levels below 70 mg/dL significantly reduces cardiovascular events in advanced chronic kidney disease (CKD) patients. This suggests a lower LDL-C target may be necessary for CKD progression.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Evidence for statin-induced LDL-C reduction benefits in chronic kidney disease (CKD) patients is limited.
- Cardiovascular disease is a major concern in advanced CKD.
- This study addresses the specific role of LDL-C levels in advanced CKD patients.
Purpose of the Study:
- To investigate the impact of maintaining lower low-density lipoprotein cholesterol (LDL-C) levels on cardiovascular outcomes in advanced CKD patients.
- To evaluate the association between different LDL-C thresholds and major adverse cardiac and cerebrovascular events (MACCEs) in stage 4 CKD.
Main Methods:
- Retrospective cohort study using the Chang Gung Research Database in Taiwan.
- Included 5367 adult patients with newly-diagnosed stage 4 CKD treated with statins.
- Patients categorized into LDL-C groups: <70 mg/dL, 70-100 mg/dL, and ≥100 mg/dL. Inverse probability of treatment weighting (IPTW) was used.
Main Results:
- The LDL-C <70 mg/dL group showed significantly lower risks of MACCEs (HR 0.77), cardiovascular death (SHR 0.75), and ischemic stroke (SHR 0.65) compared to the ≥100 mg/dL group.
- The LDL-C <70 mg/dL group also had a reduced risk of new-onset end-stage renal disease requiring dialysis (SHR 0.87).
- No significant difference in outcomes was observed for the LDL-C 70-100 mg/dL group compared to the ≥100 mg/dL group.
Conclusions:
- Maintaining LDL-C levels below 70 mg/dL appears beneficial for cardiovascular protection in advanced CKD.
- A lower LDL-C treatment target might be warranted as CKD progresses.
- These findings support more aggressive lipid management in high-risk CKD populations.
Background And Aims:
Different from other high cardiovascular (CV) risks populations, the evidence supporting the CV protective effect of LDL-C reduction with statins in chronic kidney disease (CKD) patients is comparatively scarce. This study is aimed to investigate the role of maintaining lower LDL-C level in advanced CKD patients.
Methods:
By using Chang Gung Research Database, on the basis of Taiwan's largest healthcare group, a total of 5367 adult patients newly-diagnosed with stage 4 CKD and receiving statin were extracted and further categorized into three groups based on their LDL-C levels: <70 mg/dL, 70-100 mg/dL, and ≥100 mg/dL. The main outcome is major adverse cardiac and cerebrovascular events (MACCEs), a composite of cardiovascular death, myocardial infarction, and stroke. The inverse probability of treatment weighting was performed to achieve balance of baseline characteristics.
Results:
At 5-year follow-up, the LDL-C < 70 mg/dL group exhibited significantly lower risks of MACCEs (14.3 % vs. 18.7 %, hazard ratio [HR]: 0.77, 95 % CI: 0.69-0.86), cardiovascular death (7.1 % vs. 9.7 %, subdistribution HR [SHR]: 0.75, 95 % CI: 0.65-0.88), ischemic stroke (4.1 % vs. 5.4 %, [SHR]: 0.65, 95 % CI: 0.54-0.79), and new-onset end-stage renal disease requiring chronic dialysis (25.6 % vs. 29.4 %, SHR: 0.87, 95 % CI: 0.80-0.91) compared to LDL-C > 100 mg/dL group. In contrast, the group with LDL-C levels between 70 and 100 did not significantly differ from the group with LDL-C > 100 mg/dL in study outcomes.
Conclusions:
Maintaining LDL-C lower than 70 mg/dL may be beneficial for cardiovascular protection in advanced CKD patients and a lower LDL-C treatment target may be required as CKD progression.
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