Atherosclerotic Cardiovascular Disease Events in Adults With CKD Taking a Moderate- or High-Intensity Statin: The Chronic Renal Insufficiency Cohort (CRIC) Study

Bharat Poudel; Robert S Rosenson; Vera Bittner; Orlando M Gutiérrez; Amanda H Anderson; Mark Woodward; Rajat Deo; April P Carson; Katherine E Mues; Paul J Dluzniewski; Bernard G Jaar; Claudia M Lora; Jonathan Taliercio; Paul Muntner; Lisandro D Colantonio; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators

doi:10.1016/j.xkme.2021.04.008

Atherosclerotic Cardiovascular Disease Events in Adults With CKD Taking a Moderate- or High-Intensity Statin: The Chronic Renal Insufficiency Cohort (CRIC) Study

Kidney Med. 2021 Jun 19;3(5):722-731.e1. doi: 10.1016/j.xkme.2021.04.008. eCollection 2021 Sep-Oct.

Authors

Bharat Poudel¹, Robert S Rosenson², Vera Bittner³, Orlando M Gutiérrez^{1

4}, Amanda H Anderson⁵, Mark Woodward^{6

7

8}, Rajat Deo⁹, April P Carson¹, Katherine E Mues¹⁰, Paul J Dluzniewski¹⁰, Bernard G Jaar^{8

11}, Claudia M Lora¹², Jonathan Taliercio¹³, Paul Muntner¹, Lisandro D Colantonio¹; Chronic Renal Insufficiency Cohort (CRIC) Study Investigators

Affiliations

¹ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
² Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY.
³ Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL.
⁴ Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
⁵ Department of Epidemiology, Tulane University, New Orleans, LA.
⁶ George Institute for Global Health, Imperial College London, United Kingdom.
⁷ George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁸ Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore MD.
⁹ Electrophysiology Section, Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹⁰ Center for Observational Research, Amgen Inc., Thousand Oaks, CA.
¹¹ Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore MD.
¹² Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.
¹³ Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH.

Abstract

Rationale & objective: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline uses risk stratification to guide the decision to initiate nonstatin lipid-lowering medication among adults with atherosclerotic cardiovascular disease (CVD). We determined atherosclerotic CVD (ASCVD) event rates among adults with chronic kidney disease (CKD) taking statin therapy within 2018 AHA/ACC cholesterol guideline risk categories.

Study design: Observational cohort study.

Setting & participants: Adults with CKD not on dialysis in the Chronic Renal Insufficiency Cohort (CRIC) study who were taking a moderate/high-intensity statin 1 year after enrollment (baseline for the current analysis, n = 1,753).

Exposure: 2018 AHA/ACC cholesterol guideline risk categories: without a history of ASCVD, a history of 1 major ASCVD event and multiple high-risk conditions, and a history of ≥2 major ASCVD events.

Outcome: Adjudicated ASCVD events after the year 1 study visit.

Analytical approach: We calculated age-sex standardized rates for ASCVD events and age-sex adjusted hazard ratios for ASCVD events accounting for the competing risk of death.

Results: There were 394 ASCVD events over a median follow-up period of 8 years. The ASCVD event rates (with 95% CI) per 1,000 person-years among participants without a history of ASCVD, with a history of 1 major ASCVD event and multiple high-risk conditions, and with a history of ≥2 major ASCVD events were 21.7 (18.4-25.1), 45.0 (37.8-52.3), and 73.3 (53.3-93.4), respectively. Compared with participants without a history of ASCVD, the HR (95% CI) rates for ASCVD events among those with a history of 1 major ASCVD event and multiple high-risk conditions, and with a history of ≥2 major ASCVD events were 1.89 (1.52-2.36) and 2.50 (1.85-3.39), respectively.

Limitations: Data on whether participants were taking a maximally tolerated statin dosage were unavailable.

Conclusions: The 2018 AHA/ACC cholesterol guideline identifies adults with CKD who have very high ASCVD risk despite taking a moderate/high-intensity statin.

Keywords: American Heart Association/American College of Cardiology cholesterol guideline; atherosclerotic cardiovascular disease; chronic kidney disease; moderate- or high-intensity statin; risk assessment.

Abstract

Grants and funding