Key result
ACC/AHA guidelines expand statin eligibility by ~14% vs ATP III, showing better KDIGO agreement in CKD.
Why the study?
The relationship between statin eligibility and degree of renal dysfunction using ATP III and ACC/AHA guidelines in Korean adults was unclear.
Observational (n=18,746)
In a large Korean cohort, the ACC/AHA guidelines demonstrated better agreement with KDIGO recommendations for determining statin eligibility in patients with chronic kidney disease compared to the older ATP III guidelines.
ACC/AHA may better align statin eligibility with KDIGO in Korean CKD; leaves open effects on outcomes versus ATP III.
BACKGROUND: The purpose of this study was to investigate the relationship between statin eligibility and the degree of renal dysfunction using the Adult Treatment Panel (ATP) III and the American College of Cardiology (ACC)/American Heart Association (AHA) guidelines in Korean adults. METHODS: Renal function was assessed in 18,746 participants of the Kangbuk Samsung Health Study from January 2011 to December 2012. Subjects were divided into three groups according to estimated glomerular filtration rate (eGFR): stage 1, eGFR ≥90 mL/min/1.73 m²; stage 2, eGFR 60 to 89 mL/min/1.73 m²; and stages 3 to 5, eGFR <60 mL/min/1.73 m². Statin eligibility in these groups was determined using the ATP III and ACC/AHA guidelines, and the risk for 10-year atherosclerotic cardiovascular disease (ASCVD) was calculated using the Framingham Risk Score (FRS) and Pooled Cohort Equation (PCE). RESULTS: There were 3,546 (18.9%) and 4,048 (21.5%) statin-eligible subjects according to ATP III and ACC/AHA guidelines, respectively. The proportion of statin-eligible subjects increased as renal function deteriorated. Statin eligibility by the ACC/AHA guidelines showed better agreement with the Kidney Disease Improving Global Outcomes (KDIGO) recommendations compared to the ATP III guidelines in subjects with stage 3 to 5 chronic kidney disease (CKD) (κ value, 0.689 vs. 0.531). When the 10-year ASCVD risk was assessed using the FRS and PCE, the mean risk calculated by both equations significantly increased as renal function declined. CONCLUSIONS: The proportion of statin-eligible subjects significantly increased according to worsening renal function in this Korean cohort. ACC/AHA guideline showed better agreement for statin eligibility with that recommended by KDIGO guideline compared to ATP III in subjects with CKD.
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Moon et al. (2016) conducted an observational in Renal dysfunction (n=18,746). ACC/AHA guidelines vs. ATP III guidelines was evaluated on Proportion of statin-eligible subjects. In 18,746 Korean adults, ACC/AHA guidelines identified 21.5% as statin-eligible compared to 18.9% by ATP III, with ACC/AHA showing better agreement with KDIGO in CKD (κ 0.689 vs 0.531).
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