Trends and outcome of statin therapy in dialysis patients with atherosclerotic cardiovascular diseases: A population-based cohort study

PLoS One. 2023 Jun 2;18(6):e0286670. doi: 10.1371/journal.pone.0286670. eCollection 2023.

Authors

Myunhee Lee^{1

2}, Yu Ah Hong³, Jun-Pyo Myong⁴, Kyusup Lee^{1

2}, Mahn-Won Park^{1

2}, Dae-Won Kim^{1

2}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
² Catholic Research Institute for Intractable Cardiovascular Disease CRID, College of Medicine, The Catholic University of Korea, Seoul, Korea.
³ Division of Nephrology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
⁴ Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Abstract

Background: Although statins are an effective strategy for the secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in the general population, the benefits for dialysis patients are controversial. We sought to assess trends of statin use and evaluate outcomes of statin therapy in dialysis patients with different types of ASCVD.

Methods: This nationwide retrospective population-based cohort study using data from the Korean National Health Insurance Service included adult patients (aged ≥ 18 years) undergoing chronic dialysis who had an initial ASCVD event in the time period of 2013 to 2018. Annual trends of statin use according to age, sex, and ASCVD types were analyzed. The association between 1-year mortality and statin use was examined using multivariable Cox proportional hazards regression analyses.

Results: Among 17,242 subjects, 9,611(55.7%) patients were statin users. The overall prevalence of statin use increased from 52.9% in 2013 to 57.7% in 2018; the majority (77%) of dialysis patients were prescribed moderate-intensity statins. The proportions of low- or moderate-intensity statin use were similar, but high-intensity statin use increased from 5.7% in 2013 to 10.5% in 2018. The use of the statin/ezetimibe combination has gradually increased since 2016. Statin use was independently associated with the reduced 1-year all-cause mortality after adjusting for confounding factors (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.96, P = 0.004).

Conclusion: The prevalence of statin prescriptions in dialysis patients after ASCVD event increased from 2013 to 2018. Most patients received moderate-intensity statin. However, high-intensity statin and statin/ezetimibe combination therapy has remarkably increased. Statin use was associated with decreased 1-year all-cause mortality in dialysis patients with ASCVD.

Copyright: © 2023 Lee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Atherosclerosis* / drug therapy
Atherosclerosis* / epidemiology
Atherosclerosis* / prevention & control
Cardiovascular Diseases* / drug therapy
Cardiovascular Diseases* / epidemiology
Cohort Studies
Ezetimibe
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Renal Dialysis
Retrospective Studies

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Ezetimibe

Grants and funding

This work was supported by the Research Foundation of Internal Medicine, The Catholic University of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.