As chronic kidney disease increases the risk of heart disease, patients with the former are advised to carefully manage their cholesterol levels. Now, researchers reviewing two sets of guidelines for cholesterol management have stated that nearly all people with pre-dialysis kidney disease should receive statins.
However, the study, published in the Journal of the American Society of Nephrology, also reports that 50% of chronic kidney disease (CKD) patients who should be in receipt of statins are not taking the cholesterol-lowering medication.
Co-author of the study Dr. Lisandro Colantonio, of the University of Alabama at Birmingham School of Public Health, says the findings show “there is an unmet treatment need and a missed opportunity for lowering heart disease risk among patients with CKD.”
The Centers for Disease Control and Prevention (CDC) estimate that around 10% of adults in the US – over 20 million people – could have CKD. These patients are all at an increased risk of cardiovascular disease, heart attacks and strokes.
High levels of cholesterol also increase the risk of heart disease. Statins are medicines that are routinely used to reduce cholesterol in the body, and they can play a key role in preventing the build-up of plaque in the arteries, restricting the flow of blood.
Last year, two different sets of guidelines were published regarding the management of cholesterol. One was drawn up by the American College of Cardiology/American Heart Association (ACC/AHA) and the other by the Kidney Disease Improving Global Outcomes Lipid Work Group (KDIGO).
Within the ACC/AHA guidelines, statin treatment is recommended for individuals identified as having a high risk of heart disease and stroke. People are defined as high risk if they have diabetes, high cholesterol, a history of heart problems, or a calculated 10-year risk of at least 7.5% using the “Pooled Cohorts risk equations” formula.
More simply, the KDIGO guidelines state that all individuals with CKD aged 50-79 years are recommended statin therapy.
Dr. Colantonio and his colleagues set out to investigate what impact the contrasts in these two guidelines would have upon patients. They also assessed the performance of the “Pooled Cohort risk equations” formula among patients with CKD.
Utilizing the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, the authors compared the two different sets of guidelines and calculated what the level of agreement was for statin treatment between the two of them.
Data for 4,726 CKD patients aged 50-79 years and enrolled in the study between 2003-2007 were analyzed.
The researchers observed that 92% of CKD patients were advised to receive statin therapy, according to the ACC/AHA guidelines. In comparison, the KDIGO guidelines recommended that 100% of the patients were to receive statins.
The “Pooled Cohort risk equations” formula was also found by the team to be accurate at defining risk among patients with CKD. Cardiovascular disease incidence was low among patients who did not meet the ACC/AHA criteria for statin treatment, suggesting that the formula is a valid tool in estimating heart disease risk.
“The accuracy of the pooled cohort risk equations in people with chronic kidney disease is important given their high risk for heart disease and stroke,” says Dr. Colantonio. “Physicians can use this tool in guiding therapy for patients with chronic kidney disease.”
Follow-up of the REGARDS study is currently ongoing, however. The authors note that their findings are limited by the fact that data were only available for observing the risk of cardiovascular disease for a period of 5 years. Active surveillance data was unavailable, potentially resulting in an underestimation of cardiovascular disease prevalence.
Both sets of guidelines ultimately led to similar treatment recommendations. Dr. Colantonio says the results indicate that either guideline can be used to inform the decision to initiate statin therapy for people with CKD who are 50-79 years of age.
Within their findings, the fact that 50% of patients recommended statins by the KDIGO guidelines and 42% of patients advised by the ACC/AHA to receive statins were not taking this medicine stands out. The authors conclude that increasing the appropriate use of statins in this population should be a high priority.
Previously, Medical News Today reported on a mouse trial that found statins could be effective at reversing learning disabilities caused by a genetic mutation.