Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis

Abstract

Background and objectives: Multiple meta-analyses of lipid-lowering therapies for cardiovascular primary prevention in the general population have been performed. Other meta-analyses of lipid-lowering therapies in CKD have also been performed, but not for primary prevention. This meta-analysis assesses lipid-lowering therapies for cardiovascular primary prevention in CKD.

Design, setting, participants, & measurements: A systematic review and meta-analysis using a random-effects model was performed. MEDLINE was searched between January 2012 and September 2013 for new studies using predefined search criteria without language restrictions. A number of other sources including previously published meta-analyses were also reviewed. Inclusion criteria were randomized control trials of primary prevention with lipid-lowering therapy in non-end stage CKD.

Results: Six trials were identified, five including patients with stage 3 CKD only. These studies included 8834 participants and 32,846 person-years of follow-up. All trials were post hoc subgroup analyses of statins in the general population. Statins reduced the risk of cardiovascular disease (the prespecified primary outcome) by 41% in stages 1-3 CKD compared with placebo (pooled risk ratio, 0.59; 95% confidence interval [95% CI], 0.48 to 0.72). For the secondary outcomes, the risk ratios were 0.66 (95% CI, 0.49 to 0.88) for total mortality, 0.55 (95% CI, 0.42 to 0.72) for coronary heart disease events, and 0.56 (95% CI, 0.28 to 1.13) for stroke. In study participants with stage 3 CKD specifically, the results were similar.

Conclusions: This meta-analysis suggests that the use of statins in CKD for primary prevention of cardiovascular disease is effective. These findings are consistent with recent guidance for the use of statins in all patients with CKD.

Keywords: CKD; cardiovascular disease; statins.

Figure 1.

Flow chart showing the number of studies identified and reason for inclusion or exclusion in meta-analysis. RCT, randomized controlled trial.

Figure 2.

Forest plot of risk ratios for stages 1–3 CKD cardiovascular events using a random-effects model and the Mantel–Haenszel method. M–H, Mantel–Haenszel; 95% CI, 95% confidence interval; AFCAPS, Air Force/Texas Coronary Atherosclerosis Prevention Study; CARDS, Collaborative Atorvastatin Diabetes Study; JUPITER, Justification for the Use of Statins in Prevention-an Intervention Trial Evaluating Rosuvastatin; MEGA, Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese; PREVEND IT, Prevention of Renal and Vascular Endstage Disease Intervention Trial; WOSCOPS, West of Scotland Coronary Prevention Study.

Figure 3.

Forest plot of risk ratios for stages 1–3 CKD total mortality using a random-effects model and the Mantel–Haenszel method. M–H, Mantel–Haenszel; 95% CI, 95% confidence interval; CARDS, Collaborative Atorvastatin Diabetes Study; JUPITER, Justification for the Use of Statins in Prevention-an Intervention Trial Evaluating Rosuvastatin; MEGA, Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese; PREVEND IT, Prevention of Renal and Vascular Endstage Disease Intervention Trial; WOSCOPS, West of Scotland Coronary Prevention Study