Statins of high versus low cholesterol-lowering efficacy and the development of severe renal failure
Journal
Pharmacoepidemiology and Drug Safety
Journal Volume
22
Journal Issue
6
Pages
583-592
Date Issued
2013
Author(s)
Abstract
Background: The objective of this nationwide retrospective cohort study was to examine the renal outcomes of HMG-CoA reductase inhibitor (statin) initiators. Methods: The patients who started to take statins with high cholesterol-lowering efficacy (atorvastatin and rosuvastatin) and low efficacy (lovastatin, simvastatin, pravastatin, and fluvastatin) between 1 January 2001 and 31 December 2008 were identified from the Taiwan National Health Insurance claims database. The outcome of interest was severe renal failure, defined as the composite endpoint of hemodialysis, peritoneal dialysis, and kidney transplantation. A proportional hazard regression model was applied to estimate the incidence ratio between the two groups, adjusted for the propensity scores based upon baseline characteristics. Results: Among of the 26007 and 42249 statin initiators, the crude incidence rate for developing severe renal failure was 0.65 and 0.46 per 100 person-years for the high-efficacy and low-efficacy groups, respectively. Despite that these two groups had comparable risk for myocardial infarction (hazard ratio: 1.06, 95%CI: 0.92-1.21), there was a 13% increased hazard for developing severe renal failure in the rosuvastatin and atorvastatin initiators (hazard ratio: 1.13, 95%CI: 1.02-1.26). The increased risk associated with these two statins was consistent across different risk groups (diabetes, chronic kidney disease, and ischemic heart disease). Conclusions: Statins with high cholesterol-lowering efficacy might increase the risk for developing severe renal failure. An alternative explanation is that the renal risk cannot be ameliorated as much as cardiovascular risk. Further follow-up studies or meta-analyses are needed to solve the controversy. Copyright ? 2013 John Wiley & Sons, Ltd.
SDGs
Other Subjects
atorvastatin; fluindostatin; low density lipoprotein cholesterol; mevinolin; pravastatin; rosuvastatin; simvastatin; adult; article; chronic kidney disease; cohort analysis; diabetes mellitus; disease severity; drug efficacy; female; follow up; heart infarction; heart muscle ischemia; hemodialysis; human; incidence; kidney failure; kidney transplantation; major clinical study; male; peritoneal dialysis; priority journal; treatment duration; treatment outcome; urinary excretion; Cholesterol, LDL; Cohort Studies; Databases, Factual; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Insurance Claim Review; Kidney Function Tests; Male; Renal Insufficiency; Retrospective Studies; Risk; Severity of Illness Index
Type
journal article