Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease:

a systematic review and meta-analysis

Wanyin Hou, Jicheng Lv, Vlado Perkovic, L Yang, Na Zhao, Meg Jardine, Alan Cass, Hong Zhang, Haiyan Wang

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    AIMS: The effects of statin therapy in patients with chronic kidney disease (CKD) remain uncertain. We undertook a systematic review and meta-analysis to investigate the effects of statin on major clinical outcomes.

    METHODS AND RESULTS:
     We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between 1970 and November 2011. We included prospective, randomized, controlled trials assessing the effects of statins on cardiovascular outcomes in people with kidney disease. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Thirty-one trials that include at least one event were identified, providing data for 48 429 patients with CKD, including 6690 major cardiovascular events and 6653 deaths. Statin therapy produced a 23% RR reduction (16-30) for major cardiovascular events (P<0.001), an 18% RR reduction (8-27) for coronary events, and 9% (1-16) reduction in cardiovascular or all-cause deaths, but had no significantly effect on stroke (21%, -12 to 44) or no clear effect on kidney failure events (5%, -1 to 10). Adverse events were not significantly increased by statins, including hepatic (RR 1.13, 95% CI 0.92-1.39) or muscular disorders (RR 1.02, 95% CI 0.95-1.09). Subgroup analysis demonstrated the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (P < 0.001) but that the absolute risk reductions were comparable.

    CONCLUSION:
     Statin therapy reduces the risk of major cardiovascular events in patients with chronic kidney disease including those receiving dialysis.
    Original languageEnglish
    Pages (from-to)1807-1817
    Number of pages11
    JournalEuropean Heart Journal
    Volume34
    Issue number24
    DOIs
    Publication statusPublished - 2013

    Fingerprint

    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Chronic Renal Insufficiency
    Meta-Analysis
    Kidney
    Risk Reduction Behavior
    Therapeutics
    Numbers Needed To Treat
    Kidney Diseases
    MEDLINE
    Libraries
    Renal Insufficiency
    Dialysis
    Cause of Death
    Randomized Controlled Trials
    Stroke
    Liver

    Cite this

    Hou, Wanyin ; Lv, Jicheng ; Perkovic, Vlado ; Yang, L ; Zhao, Na ; Jardine, Meg ; Cass, Alan ; Zhang, Hong ; Wang, Haiyan. / Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. In: European Heart Journal. 2013 ; Vol. 34, No. 24. pp. 1807-1817.
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    title = "Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease:: a systematic review and meta-analysis",
    abstract = "AIMS: The effects of statin therapy in patients with chronic kidney disease (CKD) remain uncertain. We undertook a systematic review and meta-analysis to investigate the effects of statin on major clinical outcomes.METHODS AND RESULTS: We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between 1970 and November 2011. We included prospective, randomized, controlled trials assessing the effects of statins on cardiovascular outcomes in people with kidney disease. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Thirty-one trials that include at least one event were identified, providing data for 48 429 patients with CKD, including 6690 major cardiovascular events and 6653 deaths. Statin therapy produced a 23{\%} RR reduction (16-30) for major cardiovascular events (P<0.001), an 18{\%} RR reduction (8-27) for coronary events, and 9{\%} (1-16) reduction in cardiovascular or all-cause deaths, but had no significantly effect on stroke (21{\%}, -12 to 44) or no clear effect on kidney failure events (5{\%}, -1 to 10). Adverse events were not significantly increased by statins, including hepatic (RR 1.13, 95{\%} CI 0.92-1.39) or muscular disorders (RR 1.02, 95{\%} CI 0.95-1.09). Subgroup analysis demonstrated the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (P < 0.001) but that the absolute risk reductions were comparable.CONCLUSION: Statin therapy reduces the risk of major cardiovascular events in patients with chronic kidney disease including those receiving dialysis.",
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    Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease: a systematic review and meta-analysis. / Hou, Wanyin; Lv, Jicheng; Perkovic, Vlado; Yang, L; Zhao, Na; Jardine, Meg; Cass, Alan; Zhang, Hong; Wang, Haiyan.

    In: European Heart Journal, Vol. 34, No. 24, 2013, p. 1807-1817.

    Research output: Contribution to journalArticleResearchpeer-review

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    T1 - Effect of statin therapy on cardiovascular and renal outcomes in patients with chronic kidney disease:

    T2 - a systematic review and meta-analysis

    AU - Hou, Wanyin

    AU - Lv, Jicheng

    AU - Perkovic, Vlado

    AU - Yang, L

    AU - Zhao, Na

    AU - Jardine, Meg

    AU - Cass, Alan

    AU - Zhang, Hong

    AU - Wang, Haiyan

    PY - 2013

    Y1 - 2013

    N2 - AIMS: The effects of statin therapy in patients with chronic kidney disease (CKD) remain uncertain. We undertook a systematic review and meta-analysis to investigate the effects of statin on major clinical outcomes.METHODS AND RESULTS: We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between 1970 and November 2011. We included prospective, randomized, controlled trials assessing the effects of statins on cardiovascular outcomes in people with kidney disease. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Thirty-one trials that include at least one event were identified, providing data for 48 429 patients with CKD, including 6690 major cardiovascular events and 6653 deaths. Statin therapy produced a 23% RR reduction (16-30) for major cardiovascular events (P<0.001), an 18% RR reduction (8-27) for coronary events, and 9% (1-16) reduction in cardiovascular or all-cause deaths, but had no significantly effect on stroke (21%, -12 to 44) or no clear effect on kidney failure events (5%, -1 to 10). Adverse events were not significantly increased by statins, including hepatic (RR 1.13, 95% CI 0.92-1.39) or muscular disorders (RR 1.02, 95% CI 0.95-1.09). Subgroup analysis demonstrated the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (P < 0.001) but that the absolute risk reductions were comparable.CONCLUSION: Statin therapy reduces the risk of major cardiovascular events in patients with chronic kidney disease including those receiving dialysis.

    AB - AIMS: The effects of statin therapy in patients with chronic kidney disease (CKD) remain uncertain. We undertook a systematic review and meta-analysis to investigate the effects of statin on major clinical outcomes.METHODS AND RESULTS: We systematically searched MEDLINE, Embase, and the Cochrane Library for trials published between 1970 and November 2011. We included prospective, randomized, controlled trials assessing the effects of statins on cardiovascular outcomes in people with kidney disease. Summary estimates of relative risk (RR) reductions were calculated with a random effects model. Thirty-one trials that include at least one event were identified, providing data for 48 429 patients with CKD, including 6690 major cardiovascular events and 6653 deaths. Statin therapy produced a 23% RR reduction (16-30) for major cardiovascular events (P<0.001), an 18% RR reduction (8-27) for coronary events, and 9% (1-16) reduction in cardiovascular or all-cause deaths, but had no significantly effect on stroke (21%, -12 to 44) or no clear effect on kidney failure events (5%, -1 to 10). Adverse events were not significantly increased by statins, including hepatic (RR 1.13, 95% CI 0.92-1.39) or muscular disorders (RR 1.02, 95% CI 0.95-1.09). Subgroup analysis demonstrated the relative effects of statin therapy in CKD were significantly reduced in people with advanced CKD (P < 0.001) but that the absolute risk reductions were comparable.CONCLUSION: Statin therapy reduces the risk of major cardiovascular events in patients with chronic kidney disease including those receiving dialysis.

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    U2 - 10.1093/eurheartj/eht065

    DO - 10.1093/eurheartj/eht065

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    EP - 1817

    JO - European Heart Journal

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