Eligibility for Statin Treatment in Asian Subjects with Reduced Renal Function: An Observational Study

다국어 초록 (Multilingual Abstract)

Background: The purpose of this study was to investigate the relationship between statin eligibility and the degree of renal dysfunctionusing 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 December2012. 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 thesegroups 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/AHAguidelines showed better agreement with the Kidney Disease Improving Global Outcomes (KDIGO) recommendations compared tothe 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 ASCVDrisk was assessed using the FRS and PCE, the mean risk calculated by both equations significantly increased as renal functiondeclined.
Conclusion: The proportion of statin-eligible subjects significantly increased according to worsening renal function in this Koreancohort. ACC/AHA guideline showed better agreement for statin eligibility with that recommended by KDIGO guideline comparedto ATP III in subjects with CKD.

참고문헌 (Reference)

1 Muntner P, "Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations" 311 : 1406-1415, 2014

2 Aronow WS, "Usefulness of echocardiographic left ventricular hypertrophy in predicting new coronary events and atherothrombotic brain infarction in patients over 62 years of age" 61 : 1130-1132, 1988

3 National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), "Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report" 106 : 3143-3421, 2002

4 Hyre AD, "The impact of reclassifying moderate CKD as a coronary heart disease risk equivalent on the number of US adults recommended lipid-lowering treatment" 49 : 37-45, 2007

5 Baigent C, "The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease(Study of Heart and Renal Protection) : a randomised placebo-controlled trial" 377 : 2181-2192, 2011

6 Weiner DE, "The Framingham predictive instrument in chronic kidney disease" 50 : 217-224, 2007

7 Barylski M, "Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy: a meta-analysis of 11randomized controlled trials involving 21,295 participants" 72 : 35-44, 2013

8 Rhee EJ, "Statin eligibility and cardiovascular risk burden assessed by coronary artery calcium score : comparing the two guidelines in a large Korean cohort" 240 : 242-249, 2015

9 "Standards of medical care in diabetes 2016: summary of revisions" 39 (39): S4-S5, 2016

10 Michaud M, "Proinflammatory cytokines, aging, and age-related diseases" 14 : 877-882, 2013

11 Gault MH, "Predicting glomerular function from adjusted serum creatinine" 62 : 249-256, 1992

12 Foster MC, "Potential effects of reclassifying CKD as a coronary heart disease risk equivalent in the US population" 63 : 753-760, 2014

13 Upadhyay A, "Lipid-lowering therapy in persons with chronic kidney disease : a systematic review and meta-analysis" 157 : 251-262, 2012

14 Levy D, "Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study" 110 : 101-107, 1989

15 Leibowitz D, "Left ventricular hypertrophy and chronic renal insufficiency in the elderly" 4 : 168-175, 2014

16 Lavie CJ, "Left ventricular geometry and mortality in patients >70 years of age with normal ejection fraction" 98 : 1396-1399, 2006

17 Wanner C, "KDIGO Clinical Practice Guideline for Lipid Management in CKD: summary of recommendation statements and clinical approach to the patient" 85 : 1303-1309, 2014

18 National Kidney Foundation, "K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification" 39 (39): S1-S266, 2002

19 Grundy SM, "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines" 110 : 227-239, 2004

20 Navaneethan SD, "HMG CoA reductase inhibitors (statins)for people with chronic kidney disease not requiring dialysis" 2 : CD007784-, 2009

21 Strippoli GF, "Effects of statins in patients with chronic kidney disease : meta-analysis and meta-regression of randomised controlled trials" 336 : 645-651, 2008

22 European Association for Cardiovascular Prevention & Rehabilitation, "ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)" 32 : 1769-1818, 2011

23 Colantonio LD, "Contrasting cholesterol management guidelines for adults with CKD" 26 : 1173-1180, 2015

24 Tonelli M, "Cholesterol and Recurrent Events (CARE) Trial Investigators. Pravastatin for secondary prevention of cardiovascular events in persons with mild chronic renal insufficiency" 138 : 98-104, 2003

25 Stevens LA, "Assessing kidney function : measured and estimated glomerular filtration rate" 354 : 2473-2483, 2006

26 Pencina MJ, "Application of new cholesterol guidelines to a population-based sample" 370 : 1422-1431, 2014

27 채현범, "Age Is the Strongest Effector for the Relationship between Estimated Glomerular Filtration Rate and Coronary Artery Calcification in Apparently Healthy Korean Adults" 대한내분비학회 29 (29): 312-319, 2014

28 Stone NJ, "2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" 129 (129): S1-S45, 2014

29 Goff DC Jr, "2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines" 63 (63): 2935-2959, 2014