Association of Low‐Density Lipoprotein Cholesterol Levels During Statin Treatment With Cardiovascular and Renal Outcomes in Patients With Moderate Chronic Kidney Disease

Abstract

Background The benefit of low‐density lipoprotein cholesterol (LDL‐C) levels in chronic kidney disease populations remains unclear. This study evaluated the cardiovascular and renal outcomes in patients with stage 3 chronic kidney disease with different LDL‐C levels during statin treatment. Methods and Results There were 8500 patients newly diagnosed as having stage 3 chronic kidney disease under statin treatment who were identified from the Chang Gung Research Database and divided into 3 groups according to their first LDL‐C level after the index date: <70 mg/dL, 70 to 100 mg/dL, and >100 mg/dL. Inverse probability of treatment weighting was performed to balance baseline characteristics. Compared with the LDL‐C ≥100 mg/dL group, the 70≤LDL‐C<100 mg/dL group exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (6.8% versus 8.8%; subdistribution hazard ratio [SHR], 0.76 [95% CI, 0.64–0.91]), intracerebral hemorrhage (0.23% versus 0.51%; SHR, 0.44 [95% CI, 0.25–0.77]), and new‐onset end‐stage renal disease requiring chronic dialysis (7.6% versus 9.1%; SHR, 0.82 [95% CI, 0.73–0.91]). By contrast, the LDL‐C <70 mg/dL group exhibited a marginally lower risk of major adverse cardiac and cerebrovascular events (7.3% versus 8.8%; SHR, 0.82 [95% CI, 0.65–1.02]) and a significantly lower risk of new‐onset end‐stage renal disease requiring chronic dialysis (7.1% versus 9.1%; SHR, 0.76 [95% CI, 0.67–0.85]). Conclusions Among patients with stage 3 chronic kidney disease, statin users with 70≤LDL‐C<100 mg/dL and with LDL‐C <70 mg/dL had similar beneficial effect in the reduction of risks of major adverse cardiac and cerebrovascular events and new‐onset end‐stage renal disease compared with those with LDL‐C >100 mg/dL. Moreover, the 70≤LDL‐C<100 mg/dL group seemed to have a lowest risk of intracerebral hemorrhage, although the incidence was low.