Statin Initiation Linked to Reduced Mortality in Chronic Kidney Disease among Older Veterans

In a breakthrough study focusing on older veterans with chronic kidney disease (CKD), researchers have discovered a potential game-changer in the form of statin initiation. The study, employing a target trial emulation design, aimed to investigate the impact of statin use on all-cause mortality and major adverse cardiovascular events (MACE) in veterans aged over 65 with CKD stages 3 to 4. The study found that Statin initiation in US veterans over 65 with CKD stages 3 to 4 and no prior atherosclerotic cardiovascular disease (ASCVD) was associated with a lower risk of all-cause mortality but did not significantly impact the occurrence of MACE

The study results were published in the journal JAMA Network Open. 

Atherosclerotic cardiovascular disease is the leading cause of death among adults with chronic kidney disease. Some evidence supports the use of statins for the primary prevention of ASCVD in older patients with CKD. While statins are widely known for their efficacy in preventing cardiovascular events, their utility in individuals with CKD has been a subject of limited data and exploration. Due to uncertainty in the evidence researchers from Massachusetts conducted a study to evaluate the association of statin use with all-cause mortality and major adverse cardiovascular events (MACE) among US veterans older than 65 years with CKD stages 3 to 4

The study was conducted as a cohort study, by utilizing a target trial emulation design and involving veterans diagnosed with moderate CKD between 2005 and 2015. Participants were aged over 65, within 5 years of CKD diagnosis, without prior atherosclerotic cardiovascular disease (ASCVD) or statin use, and had at least 1 clinical visit in the year before the trial baseline. Propensity weighting was applied for a meticulous analysis of the outcomes.

Findings:

• The comprehensive analysis included 14,828 veterans, with a mean age of 76.9 years at CKD diagnosis.
• The results, after propensity score adjustment, were striking.
• Statin initiators exhibited a significantly lower risk of all-cause mortality (hazard ratio 0.91, 95% CI 0.85-0.97) compared to noninitiators.
• This finding suggests a noteworthy association between statin initiation and a reduced risk of mortality in this specific population.
• However, the study did not find a significant impact on the occurrence of major adverse cardiovascular events (MACE) with statin use.
• The hazard ratio for MACE was 0.96 (95% CI 0.91-1.02), indicating that statin initiation did not result in a statistically significant reduction in MACE.

These findings carry significant implications for the management of CKD in older veterans. While statin initiation demonstrated a clear association with lower all-cause mortality, the lack of a substantial impact on MACE suggests a need for further research.

The study underscores the importance of considering statin therapy in the care plan for older veterans with CKD, emphasizing the potential for mortality reduction. However, the researchers emphasize the necessity for confirmation through randomized clinical trials to establish a robust evidence base and inform clinical guidelines.

Further reading: Barayev O, Hawley CE, Wellman H, et al. Statins, Mortality, and Major Adverse Cardiovascular Events Among US Veterans With Chronic Kidney Disease. JAMA Netw Open. 2023;6(12):e2346373. doi:10.1001/jamanetworkopen.2023.46373