Renal Function and Effect of Statin Therapy on Cardiovascular Outcomes in Patients Undergoing Coronary Revascularization (from the CREDO-Kyoto PCI/CABG Registry Cohort-2)
Abstract
Although statin therapy is essential for secondary cardiovascular prevention, the therapeutic effect of statins on cardiovascular outcomes in patients with advanced chronic kidney disease (CKD) after coronary revascularization has not been fully elucidated. In the CREDO-Kyoto Registry Cohort-2, 14,706 patients who underwent first coronary revascularization were divided into 4 strata based on estimated glomerular filtration rate (eGFR) or status of hemodialysis (HD). Patients in each stratum were further divided into 2 groups based on statin therapy at discharge: non-CKD stratum (eGFR ≥60 ml/min/1.73 m(2)), 8,959 patients (statin, n = 4,747; no statin, n = 4,212); mild CKD stratum (eGFR ≥30 to <60 ml/min/1.73 m(2)), 4,567 patients (statin, n = 2,135; no statin, n = 2,432); severe CKD stratum (eGFR <30 ml/min/1.73 m(2)), 608 patients (statin, n = 229; no statin, n = 379); and HD stratum, 572 patients (statin, n = 117; no statin, n = 455). Median follow-up duration was 956 days (interquartile range 699 to 1,245). Adjusted risk for major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, or stoke) was significantly lower in the statin group than in the no-statin group in the non-CKD (hazard ratio 0.8, 95% confidence interval 0.68 to 0.95, p = 0.01) and mild CKD (hazard ratio 0.69, 95% confidence interval 0.56 to 0.84, p = 0.0002) strata. However, a significant association of statin therapy and lower risk for MACEs was not seen in the severe CKD (hazard ratio 0.91, 95% confidence interval 0.6 to 1.38, p = 0.65) and HD (hazard ratio 1.04, 95% confidence interval 0.64 to 1.69, p = 0.87) strata. In conclusion, statin therapy was associated with significantly lower risk for MACEs in patients with non-CKD and mild CKD undergoing coronary revascularization. However, therapeutic benefits of statins were not apparent in patients with severe CKD and HD.
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Post hoc analyses of secondary prevention studies have shown that high-dose statin treatment decreases cardiovascular events significantly, by approximately 30%, in patients with moderate CKD compared to the usual dose.
“Furthermore, post hoc analyses of secondary prevention studies have shown that high-dose statin treatment decreases cardiovascular event significantly, by approximately 30%, in patients with moderate CKD compared to the usual dose773, 774).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [773]
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- Authors
- Natsuaki, M., Furukawa, Y., Morimoto, T., Sakata, R., & Kimura, T.
- Affiliations
- Kyoto University (JP)
- Kobe City Medical Center General Hospital (JP)
- Kindai University (JP)
- Corresponding author
- Furukawa, Yutaka
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 110
- Issue
- 11
- Pages
- 1568-1577
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1980656569
- Cited by
- 35
- References
- 27
- Citations by year
- 2026: 1 · 2025: 1 · 2022: 2 · 2021: 6 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 2 · 2015: 6 · 2014: 1 · 2013: 2
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Japan Society for the Promotion of Science (24531210, 23659256, 22390103)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- statin therapy, chronic kidney disease, renal function, major adverse cardiovascular events, coronary revascularization, percutaneous coronary intervention, coronary artery bypass grafting, estimated glomerular filtration rate, hemodialysis, secondary prevention, cardiovascular outcomes, CREDO-Kyoto registry
- MeSH terms
- Aged, Coronary Artery Disease, Female, Follow-Up Studies, Glomerular Filtration Rate, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Middle Aged, Myocardial Revascularization, Registries, Retrospective Studies, Time Factors, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Drug-Eluting Stents
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