Key result
Lipid-lowering therapy remains largely static in ASCVD and CKD, unchanged in ~62% over 2 years.
Why the study?
Despite guideline recommendations, the use and optimization of lipid-lowering therapies in patients with CKD and ASCVD remain suboptimal and need further characterization.
Observational (n=3,304)
Despite guideline recommendations, rates of high-intensity statin and ezetimibe use remain low in patients with CKD and ASCVD, highlighting a significant opportunity to optimize lipid-lowering therapy.
Background Chronic kidney disease (CKD) is a known risk factor of atherosclerotic cardiovascular disease (ASCVD). Per the 2018 American Heart Association/American College of Cardiology cholesterol guidelines, high‐risk ASCVD patients with CKD and low‐density lipoprotein cholesterol (LDL‐C) levels 70 mg/dL should take a high‐intensity statin with ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). Objective/Methods We examined the changes in use of lipid lowering therapies (LLT) over two years in 3304 patients with ASCVD and CKD in the Getting to an imprOved Understanding of Low‐Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD) observational cohort study. Results Of those with eGFR <60 ml/min/1.73 m2, 21.6% (171/791) had intensification of LLT while 10.4% (82/791) had de‐escalation of LLT. Notably, 61.6% (487/791) had no change in LLT regimen over 2 years. Statin use was 83.2% (785/944) at baseline and 80.1% (634/791) at 2 years. Statin/ezetimibe use increased from 2.9% (27/944) to 4.9% (39/791). Statin discontinuation at 2 years was greater with lower eGFR levels across all cohorts. Conclusion Despite the recommendations of multiscociety guidelines, statin use, while high, is not ubiquitous and rates of high‐intensity statin and ezetimibe use remain low in patients with CKD. There remains a significant opportunity to optimize LLT and achieve atheroprotective cholesterol levels in the CKD population.
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Shaik et al. (2022) conducted an observational in Atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD) (n=3,304). Lipid lowering therapies was evaluated on Changes in use of lipid lowering therapies over two years. In patients with ASCVD and CKD, 61.6% had no change in lipid-lowering therapy over 2 years, with overall statin use slightly decreasing from 83.2% to 80.1%.
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