In moderate CKD patients with apparent proteinuria, LDL-C levels < 70mg dL provide CV and renal benefits: JAHA

The researchers observed a reduction in risks of new‐onset end‐stage renal disease and major adverse cardiac and cerebrovascular events in statin users with 70≤LDL‐C<100 mg/dL and with LDL‐C <70 mg/dL. The study findings were published in the Journal of the American Heart Association.

Previous studies have indicated a low level of high, low‐density lipoprotein cholesterol (LDL‐C) is the leading cause of atherosclerotic cardiovascular disease and resultant cardiovascular deaths. Statin is a 3‐hydroxy‐3‐methylglutaryl‐coenzyme A inhibitor that can effectively lower LDL-C levels and, therefore, has been used as a lipid-lowering agent.

Chronic kidney disease patients need special consideration in lipid management compared to other high‐risk groups. The association between LDL‐C levels and cardiovascular outcomes in CKD patients seems less noticeable, and the role of statin therapy in this population is unclear compared with that in other high‐risk people.

Against the above background, Chieh‐Li Yen, Chang Gung University, Taoyuan, Taiwan, and colleagues aimed to evaluate the outcomes of statin therapy in patients with moderate CKD with an LDL‐C level of <70 mg/dL, 70 to 100 mg/dL, and >100 mg/dL; these are the commonly used cutoff points in the current lipid management guidelines.

The researchers identified 8500 patients newly diagnosed as having stage 3 under statin treatment from the Chang Gung Research Database. The patients were divided into three groups based on their first LDL-C level after the index date: <70 mg/dL, 70 to 100 mg/dL, and >100 mg/dL.

The study demonstrated the following findings:

• Compared with the LDL‐C ≥100 mg/dL group, the 70≤LDL‐C<100 mg/dL group exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (6.8% versus 8.8%; subdistribution hazard ratio [SHR], 0.76), intracerebral hemorrhage (0.23% versus 0.51%; SHR, 0.44), and new‐onset end‐stage renal disease requiring chronic dialysis (7.6% versus 9.1%; SHR, 0.82).
• By contrast, the LDL‐C <70 mg/dL group exhibited a marginally lower risk of major adverse cardiac and cerebrovascular events (7.3% versus 8.8%; SHR, 0.82) and a significantly lower risk of new‐onset end‐stage renal disease requiring chronic dialysis (7.1% versus 9.1%; SHR, 0.76).

"Among stage 3 CKD, statin users with 70≤LDL‐C<100 mg/dL and LDL‐C <70 mg/dL exhibited comparable beneficial responses for reducing cardiovascular events and new‐onset ESRD versus those with LDL‐C >100 mg/dL," the researchers wrote in their conclusion. "The 70≤LDL‐C<100 mg/dL group showed a favorable outcome in intracerebral hemorrhage, albeit with a lower incidence rate."

"For people younger than 65 years or with evident proteinuria, controlling LDL‐C levels <70 mg/dL might be slightly more beneficial." The researchers, however, suggest that only one single observational study is enough to draw any firm conclusion. "There is a need for further validation of the findings by well-designed prospective studies."

Reference:

The study, "Association of Low‐Density Lipoprotein Cholesterol Levels During Statin Treatment With Cardiovascular and Renal Outcomes in Patients With Moderate Chronic Kidney Disease," was published in the American Heart Association. DOI: https://doi.org/10.1161/JAHA.122.027516