The medications may lower cholesterol levels in advanced chronic kidney disease patients, but they do not appear to reduce the number of cardiovascular events and may interact with other drugs the patients are taking.
The findings of a new review suggest that statins do little to prevent cardiovascular events in patients with advanced stages of chronic kidney disease (CKD).
CKD patients are 23 times more likely to develop cardiovascular disease, and cardiovascular events are the leading cause of death for these patients. Statins are commonly prescribed to CKD patients to help lower cholesterol with the overall goal of preventing cardiovascular disease and cardiovascular-related deaths. The review
, published online on August 24, 2013, in the American Journal of Cardiovascular Drugs
, analyzed recent trials studying the efficacy of statin use for primary prevention of cardiovascular events in CKD patients.
The analysis identified a few studies that suggested statins were associated with a decrease in cardiovascular risk in patients with CKD in stages 2 to 4. The Pravastatin Pooling Project, which combined data from 3 randomized trials, found that statin use reduced the risk for heart attack, coronary death, and percutaneous and surgical revascularization by 4.5% in patients with CKD alone and by 6.4% in patients with CKD and diabetes. Similar results were reported in the Study of Heart and Renal Protection (SHARP), the largest randomized study of statins in kidney disease patients. For patients who received simvastatin or a combination of ezetimibe and simvastatin, major vascular events were reduced by 15% and major atherosclerotic events were reduced by 17%.
In more advanced stages of the disease, however, statins did not decrease the risk for cardiovascular events. The results of 1 observational study and 3 major clinical studies indicated that statins were ineffective in reducing cardiovascular events in dialysis patients. In 1 clinical trial, dialysis patients were randomized to atorvastatin or placebo and were followed for 3 years. At the end of the study, statin patients reduced their LDL cholesterol by 42%. However, there was no significant difference in the number of cardiovascular events experienced by patients who received statins and those who received placebo. Similar results were produced in a study of rosuvastatin in dialysis patients. After a median of 3.2 years, there was no significant difference in the occurrence of heart attack, stroke, or death from cardiovascular disease between patients who received statins and those who received placebo.
In yet another trial, statins improved cholesterol levels without reducing the risk for cardiovascular events in transplant patients. In the trial, which evaluated the effects of fluvastatin on cardiovascular death in renal transplant recipients, there was no significant reduction in major cardiac events after a median follow-up of 5 years.
In addition, statins did not appear to slow the progression of kidney disease in any large clinical outcome study, as has been previously suggested.
As a result of their findings, the review authors suggest that statins should be prescribed less frequently and at lower doses in kidney disease patients. They also note that although statins are safe when used appropriately, kidney disease patients are at increased risk for potential interactions with other medications.
“I believe the evidence shows that the majority of people with chronic kidney disease are taking statins inappropriately," said lead review author Ali Olyaei, PharmD, a professor of pharmacotherapy in the College of Pharmacy at Oregon State University, in a press release. “They may help a little in early-stage disease, but those people are not the ones who generally die from cardiovascular diseases. And by the end stages the risks outweigh any benefit. More drugs are not always better.”