The Protective Effects of Lipid-Lowering Agents on Cardiovascular Disease and Mortality in Maintenance Dialysis Patients: Propensity Score Analysis of a Population-Based Cohort Study.

Ming-Hsien Tsai,Hung-Hsiang Liou,Yu-Wei Fang,Yen-Chun Huang,Mingchih Chen

doi:10.3389/fphar.2021.804000

Ming-Hsien Tsai, Hung-Hsiang Liou + Show 3 more

Open Access

https://doi.org/10.3389/fphar.2021.804000

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Abstract

Lipid-lowering agents display limited benefits on cardiovascular diseases and mortality in patients undergoing dialysis. Therefore, they are not routinely recommended for dialysis patients. The aim of this study was to assess the effects of lipid-lowering agents on clinical outcomes in dialysis patients on the basis of real-world evidence. This research used Taiwan’s National Health Insurance Research Database to identify dialysis patients from January 2009 to December 2015; patients were then categorized into a case group treated with lipid-lowering agents (n = 3,933) and a control group without lipid-lowering agents (n = 24,267). Patients were matched by age, sex, and comorbidities in a 1:1 ratio. This study used the Cox regression model to estimate the hazard ratios (HRs) for mortality and major adverse cardiovascular events (MACEs) for events recorded until December 2017. During a mean follow-up period of approximately 3.1 years, 1726 [43.9%, incidence 0.123/person-year (PY)] deaths and 598 (15.2%, incidence 0.047/PY) MACEs occurred in the case group and 2031 (51.6%, incidence 0.153/PY) deaths and 649 (16.5% incidence 0.055/PY) MACEs occurred in the control group. In the multivariable analysis of the Cox regression model, lipid-lowering agent users showed a significantly lower risk of death [HR: 0.75; 95% confidence interval (CI): 0.70–0.80] and MACEs (HR: 0.88; 95% CI: 0.78–0.98) than lipid-lowering agent non-users. Moreover, the survival benefit of lipid-lowering agents was significant across most subgroups. Dialysis patients treated with lipid-lowering agents display a 25 and 12% reduction in their risk of mortality and MACEs, respectively. Therefore, lipid-lowering agents might be considered when treating dialysis patients with hyperlipidemia.

Highlights

Patients with chronic kidney disease (CKD) are at a high risk of morbidity and mortality owing to cardiovascular disease (CVD) (Jankowski et al, 2021); the risk of CVD starts from an early CKD stage and increases along with a decline in the estimated glomerular filtration rate (Yu et al, 2021)
We have provided real-world evidence on the effects of lipidlowering agents in reducing cardiovascular events and mortality in dialysis patients using an National Health Insurance Research Database (NHIRD) dataset
This finding is crucial to disclose that dyslipidemia correction still plays a role in the improvement of CVD and mortality in dialysis patients, which belong to the high-risk CVD group

Summary

Introduction

Patients with chronic kidney disease (CKD) are at a high risk of morbidity and mortality owing to cardiovascular disease (CVD) (Jankowski et al, 2021); the risk of CVD starts from an early CKD stage and increases along with a decline in the estimated glomerular filtration rate (Yu et al, 2021). While entering into dialysis-dependent end-stage renal disease (ESRD), the risk of CVD significantly increases compared with that in the general population, accounting for >50% of the mortality (Chronic Kidney Disease Prognosis Consortium et al, 2010; Sharma and Sarnak, 2017; Johansen et al, 2021). The benefit of statin therapy in CVD is well studied, and it is recommended for the primary prevention of CVD in those at a high risk of atherosclerosis (Ziaeian and Fonarow, 2017; Arnett et al, 2019; Byrne et al, 2019). The degree of vascular smooth muscle cell proliferation and endothelial cell apoptosis was proportional to the degree of LDL carbamylation and subsequently induced accelerated atherosclerosis (Ok et al, 2005; Apostolov et al, 2010)

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