Could Statins Reduce Death Risk In Chronic Kidney Disease

A cohort study of 14,828 US veterans aged over 65 with stage 3 or 4 chronic kidney disease found that starting a statin was associated with a 9% lower risk of death over an average 3.6 years. The study did not prove causation, and its reduction in major cardiovascular events was not statistically significant.  

Could Statins Reduce Death Risk In Chronic Kidney Disease
Medically reviewed

Dr. Chrysoula I. Liakou MD, PhD Google Scholar LinkedIn

Internal Medicine Specialist
Cancer Immunology Researcher

What the Study Found About Statins and Survival in Chronic Kidney Disease

  • Statins are an affordable and well-tolerated medication that can lower the risk of death from cardiovascular events by reducing levels of low-density lipoprotein (LDL) cholesterol, commonly known as 'bad' cholesterol, in the bloodstream.

  • Initially prescribed primarily to individuals who have suffered heart attacks, the guidelines for statin usage are continuously evolving to encompass a broader range of people who might gain from using the medication.

  • A recent study indicated that all individuals aged 40 and above with human immunodeficiency virus (HIV) could experience benefits from taking statins.

  • Furthermore, a separate trial demonstrated that older adults with chronic kidney disease could also find statins advantageous.


In 2020, more doctors prescribed statins than any other medicine, and they keep updating the guidelines to recommend using them for more people.


Back in the late 1980s, doctors started giving statins mainly to folks who had heart attacks to stop them from having more. Statins are like a tool to lower "bad" cholesterol (LDL). Doing that helps keep your arteries from getting stiff and narrow, which can lead to high blood pressure.


Before statins, the main things doctors told people to do to prevent heart problems were to eat right and exercise. But now, research has shown that statins can often do a better job of lowering LDL cholesterol than just changing your diet and being active.

 

Statins’ Effect On Cholesterol And Health


Statins are medicines that help lower a type of cholesterol called LDL. This can be important for our health. Two scientists won a Nobel Prize in 1985 for discovering how our bodies control cholesterol.


A study in 2002 found that if people at high risk of heart problems took a statin called simvastatin every day, they lowered their chances of having a heart attack or stroke by 25% over five years.


Since the late 1980s, doctors have started using statins more widely to help people who might have heart issues in the next ten years.


Recently, there was an extensive study called the REPRIEVE trial. It showed that a statin called pitavastatin can reduce the risk of heart problems by 35% in people with HIV. Now, some people are saying that everyone with HIV who is over 40 should think about taking statins to protect their heart.

 

Can Statins Help In Kidney Disease?


A recent study published in JAMA Network Open has indicated that older individuals, predominantly men, who have chronic kidney disease may see benefits from using statins.


The study collected data from U.S. veterans aged 65 and above, drawing from sources like Veterans Affairs, Medicaid, and Medicare. The focus was on those with moderate chronic kidney disease, specifically stages 3 or 4. The vast majority of the participants were male, with an average age of 76.9 at the time of their chronic kidney disease diagnosis.


Researchers examined data from 17,609 veterans, dividing them into two groups: 14,685 individuals with chronic kidney disease who were not using statins and 2,924 individuals with kidney disease who were offered statins. They monitored all these participants for about 3.6 years.


The results revealed that taking statins reduced the overall mortality rate among veterans with chronic kidney disease by 9%. While there was also a decrease in the number of major adverse cardiovascular events observed among those who took statins, this difference was not statistically significant.

 

How Statins Might Reduce Death Risk In Kidney Disease

In a recent study, researchers found something interesting but didn't explain why. They suggested researching with a controlled trial to learn more about the medication's side effects.


A scientist who knows about inflammation suggested a possible reason for the findings. The medicine might work by reducing inflammation in the body. This could be helpful for people with diseases linked to inflammation, like chronic kidney disease.


The scientist also said that while the medicine might help with chronic kidney disease, it might not work as well for heart problems. This could be because the medication can have some harmful side effects, like hurting your muscles or causing diabetes.


The leading researcher in the study also thinks that inflammation might be the key to understanding these findings. People with chronic kidney disease often have more inflammation in their bodies, and they also have a higher chance of heart problems. So, the medicine might be helpful because it can lower inflammation.

 

Insufficient Evidence On The Safety Of Statins In Older Individuals


Researchers focused on a specific group because there wasn't enough information about how statin medications affect older individuals.


A study in 2022 by the U.S. Preventative Services Task Force found that we don't have enough evidence to say whether statins are good or bad for people over 76.


This is a big deal because we need to understand how statins work in the growing group of older adults, especially those over 75. They're at a higher risk of heart problems, but research in the past didn't include them.


It's not just older folks who were left out of these studies. Women and people with conditions like rheumatoid arthritis were also overlooked. But now, we're starting to see signs that statins might help reduce the risk of heart attacks in these groups, too.


So, the goal is to have more diverse groups of people in future studies to figure out how statins can help or hurt different populations.


You can consult Mobi Doctor for medical advice and assistance via telehealth services.



Statins and Chronic Kidney Disease Mortality FAQs

Evidence suggests statins reduce mortality in many adults with chronic kidney disease who are not receiving dialysis. In the featured study, starting a statin was associated with a 9% lower risk of death among older adults with stage 3 or 4 CKD and no previous atherosclerotic cardiovascular disease. Randomised evidence also supports mortality and cardiovascular benefits in non-dialysis CKD.

The study included 14,828 US veterans older than 65 with stage 3 or 4 chronic kidney disease. Their average age at diagnosis was 76.9 years, 99% were men, and none had previously used statins or been diagnosed with atherosclerotic cardiovascular disease. These characteristics limit how confidently the findings can be applied to women, younger adults or more diverse populations.

A 9% lower risk refers to a relative association between statin initiation and mortality, represented by a hazard ratio of 0.91. It does not mean that statins prevented nine deaths among every 100 patients. The absolute benefit for an individual depends on their baseline cardiovascular risk, age, kidney function, other health conditions and expected treatment duration.

The study did not demonstrate a statistically significant reduction in major cardiovascular events. Statin users had a 4% lower estimated risk of the combined outcome, which included heart attack, stroke, transient ischaemic attack, revascularisation and death, but the confidence interval included no effect. Broader randomised evidence nevertheless supports cardiovascular benefits in people with non-dialysis CKD.

Statins lower LDL cholesterol and reduce the formation and rupture of fatty plaques within arteries. This is particularly relevant because chronic kidney disease substantially increases cardiovascular risk. Although anti-inflammatory effects have also been proposed, the featured study was designed to examine health outcomes rather than determine exactly why mortality was lower among statin users.

Statins are not primarily used to restore kidney function or stop CKD progression. A large Cochrane review found that they reduced death, heart attacks and major cardiovascular events in non-dialysis CKD but probably made little or no difference to kidney failure. Their principal established role is reducing cardiovascular risk rather than directly increasing eGFR or repairing kidney damage.

KDIGO recommends statin-based treatment for most adults aged 50 or older with CKD who are not receiving chronic dialysis. For adults aged 18 to 49, treatment is considered when additional risks are present, such as diabetes, coronary disease, a previous ischaemic stroke or a sufficiently high predicted cardiovascular risk. The exact medicine and dose require individual review.

Statins are generally not started solely for primary cardiovascular prevention after a person has become dialysis-dependent because trials show substantially less evidence of benefit in this group. Someone already taking a statin when dialysis begins may be advised to continue it. Established cardiovascular disease, previous treatment and individual risks should guide the decision rather than stopping or starting medication without review.

Statins are generally well tolerated in CKD, but the appropriate product and dose depend on kidney function, other medicines and individual risk factors. Muscle aches can occur, while severe muscle injury is rare. Unexplained marked weakness, severe muscle pain or dark urine requires prompt assessment. Potential medicine interactions and liver monitoring should also be considered before and during treatment.


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