Key result
European guidelines qualify ~46% more US CKD patients for statins than US guidelines.
Why the study?
Clinical implications of differing statin eligibility guidelines for patients with CKD have not been examined.
Cross-Sectional
Nearly half of US adults aged 40-75 with CKD have a low 10-year ASCVD risk, highlighting a major discrepancy in statin eligibility between US and European/KDIGO guidelines.
US clinicians may miss statin candidates among low-risk CKD patients per European criteria; challenges US thresholds and supports guideline harmonization research.
BACKGROUND: Chronic kidney disease (CKD) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). American cardiovascular societies consider CKD a risk-enhancing factor that supports statin therapy in intermediate-risk patients aged 40-75 years. In contrast, European cardiovascular societies recommend statins for all middle-aged adults with CKD. The Kidney Disease: Improving Global Outcomes lipid management guideline for CKD recommends statin therapy for all patients with CKD >50 years. Clinical implications for these differences have not been examined. OBJECTIVE: This study examines CKD prevalence and statin eligibility in non-ASCVD adults, representative of the US population, at 3 levels of 10-year risk of ASCVD estimated by pooled cohort equations. METHODS: . Overall prevalence of low, intermediate, and high 10-year risk for ASCVD was determined. RESULTS: ; 7.5% (confidence interval 6.9%, 8.1%) had CKD. Among participants with CKD, 46.3% had 10-year risk for ASCVD <7.5% (low risk); 31.7% had intermediate risk (7.5-< 20%), and 22.0% had high risk (≥20%). In participants with CKD, 62.5% were women. A total of 19.6% of all participants with CKD had diabetes. A total of 46.3% of participants with CKD at intermediate or high risk reported taking cholesterol-lowering drugs. CONCLUSION: A total of 46.3% of patients with CKD aged 40-75 years had 10-year risk <7.5% (low risk) and hence were statin eligible by European and Kidney Disease: Improving Global Outcomes (>50 years) guidelines. US cardiovascular guidelines limit statin eligibility to intermediate- and high-risk CKD. Statin eligibility in lower-risk patients may be best determined by measuring coronary artery calcium.
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Vega et al. (2020) conducted a cross-sectional in Chronic kidney disease. Chronic kidney disease was evaluated on Prevalence of low (<7.5%) 10-year risk for ASCVD among participants with CKD. Among US adults with chronic kidney disease, 46.3% had a low 10-year ASCVD risk (<7.5%), making them statin-eligible by European but not US guidelines.
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