- Continuation of statin therapy after transition to dialysis is associated with significantly reduced all-cause and cardiovascular (CV) mortality.
Why this matters
- Current guidelines advocate statin continuation, but clinical evidence is lacking; de novo use is not recommended.
- Retrospective study of 14,298 US veterans (mean age, 71±10 years) receiving statins over the 1-year period before dialysis, surviving ≥1 year postdialysis.
- 83.5% continued statins (≥6 months during dialysis) and 16.5% did not.
- Participants were primarily males (96.7%) with diabetes (74.6%); 21.3% were African-American.
- Funding: NIH, US Department of Veterans Affairs (VA).
- In the second year after dialysis initiation, 19.2% of patients died, 1.2% were censored for renal transplant, and 2.5% were lost to follow-up.
- At 1 year posttransition, continued statin use yielded (per 100 person-years):
- Fewer deaths vs nonuse (21.9 [95% CI, 20.9-22.8] vs 30.3 [95% CI, 27.8-32.8]).
- Fewer CV deaths vs nonuse (8.1 [95% CI, 7.5-8.6] vs 9.8 [95% CI, 8.3-11.2]).
- In adjusted analysis, continued statin use was tied to a 28% reduced risk for all-cause mortality (HR=0.72; 95% CI, 0.66-0.79) and 18% reduced risk for CV mortality (HR=0.82; 95% CI, 0.69-0.96).
- Findings supported in subgroup analysis by age, race, and diabetes status.
- Observational design.
- Reasons for statin discontinuation not captured.