Use of lipid-lowering therapies in patients with chronic kidney disease and atherosclerotic cardiovascular disease: 2-year results from Getting to an imprOved Understanding of Low-Density lipoprotein cholesterol and dyslipidemia management (GOULD)

Abstract

Background: Chronic kidney disease (CKD) is a known risk factor of atherosclerotic cardiovascular disease (ASCVD). Per the 2018 American Heart Association/American College of Cardiology cholesterol guidelines, high-risk ASCVD patients with CKD and low-density lipoprotein cholesterol (LDL-C) levels $\ge$ 70 mg/dL should take a high-intensity statin with ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i).

Objective/methods: We examined the changes in use of lipid lowering therapies (LLT) over two years in 3304 patients with ASCVD and CKD in the Getting to an imprOved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) observational cohort study.

Results: Of those with eGFR <60 ml/min/1.73 m² , 21.6% (171/791) had intensification of LLT while 10.4% (82/791) had de-escalation of LLT. Notably, 61.6% (487/791) had no change in LLT regimen over 2 years. Statin use was 83.2% (785/944) at baseline and 80.1% (634/791) at 2 years. Statin/ezetimibe use increased from 2.9% (27/944) to 4.9% (39/791). Statin discontinuation at 2 years was greater with lower eGFR levels across all cohorts.

Conclusion: Despite the recommendations of multiscociety guidelines, statin use, while high, is not ubiquitous and rates of high-intensity statin and ezetimibe use remain low in patients with CKD. There remains a significant opportunity to optimize LLT and achieve atheroprotective cholesterol levels in the CKD population.

Keywords: atherosclerosis; cholesterol; chronic kidney disease; coronary artery disease; ezetimibe; lipids; statins.

Figure 1

Change in lipid‐lowering therapy use over 2 years. Mild decreases in statin use were noted over two years across eGFR groups. There were modest increases in use of high‐intensity statin, particularly among eGFR 30–<60, and minimal change in the use of other lipid‐lowering therapies (LLT). While increases in ezetimibe/statin use were observed, overall prevalence remains low. *Other LLT include: Fibrate, Niacin, Mipomersen, Lomitapide, Cholestyramine, Colesevelam, Colestipol, and other unclassified medications.