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. 2019 Jan 27;12(4):530-537.
doi: 10.1093/ckj/sfy131. eCollection 2019 Aug.

Low statin use in nondialysis-dependent chronic kidney disease in the absence of clinical atherosclerotic cardiovascular disease or diabetes

Talar W Markossian  1   2 , Holly J Kramer  2   3   4 , Nicholas J Burge  4 , Ivan V Pacold  3   4 , David J Leehey  3   4 , Zhiping Huo  1 , Julia Schneider  3   4 , Benjamin Ling  3   4 , Kevin T Stroupe  1   2
Affiliations

Low statin use in nondialysis-dependent chronic kidney disease in the absence of clinical atherosclerotic cardiovascular disease or diabetes

Talar W Markossian et al. Clin Kidney J. .

Abstract

Background: Both reduced glomerular filtration rate and increased urine albumin excretion, markers of chronic kidney disease (CKD), are associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). However, CKD is not recognized as an ASCVD risk equivalent by most lipid guidelines. Statin medications, especially when combined with ezetimibe, significantly reduce ASCVD risk in patients with nondialysis-dependent CKD. Unless physicians recognize the heightened ASCVD risk in this population, statins may not be prescribed in the absence of clinical cardiovascular disease or diabetes, a recognized ASCVD risk equivalent. We examined statin use in adults with nondialysis-dependent CKD and examined whether the use differed in the presence of clinical ASCVD and diabetes.

Methods: This study ascertained statin use from pharmacy dispensing records during fiscal years 2012 and 2013 from the US Department of Veterans Affairs Healthcare System. The study included 581 344 veterans aged ≥50 years with nondialysis-dependent CKD Stages 3-5 with no history of kidney transplantation or dialysis. The 10-year predicted ASCVD risk was calculated with the pooled risk equation.

Results: Of veterans with CKD, 62.1% used statins in 2012 and 55.4% used statins continuously over 2 years (2012-13). Statin use in 2012 was 76.2 and 75.5% among veterans with CKD and ASCVD or diabetes, respectively, but in the absence of ASCVD, diabetes or a diagnosis of hyperlipidemia, statin use was 21.8% (P < 0.001). The 10-year predicted ASCVD risk was ≥7.5% in 95.1% of veterans with CKD, regardless of diabetes status.

Conclusions: Statin use is low in veterans with nondialysis-dependent CKD in the absence of ASCVD or diabetes despite high-predicted ASCVD risk. Future studies should examine other populations.

Keywords: cardiovascular disease; chronic kidney disease; epidemiology; prevention; statin medication.

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Figures

FIGURE 1:
FIGURE 1:
Statin use in veterans with nondialysis-dependent CKD by CKD stage, fiscal years (FYs) 2012–13, n = 581 344.
FIGURE 2:
FIGURE 2:
Percentage of veterans with statin use in FY 2012 by CKD stage and comorbidities, n = 581 344.
FIGURE 3:
FIGURE 3:
Type of statin use among veterans with nondialysis-dependent CKD.
See this image and copyright information in PMC

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