High-Intensity Statin for Cardiovascular Disease and Comorbid Chronic Kidney Disease

In patients with clinical atherosclerotic cardiovascular disease (ASCVD) and comorbid nondialysis chronic kidney disease (CKD), the use of high-intensity statin therapy is recommended to reduce the risk for cardiovascular events.

A retrospective, cross-sectional, observational study assessing prescribing patterns of statin therapy in patients with ASCVD and CKD was conducted, and the results were presented at the National Lipid Association (NLA) Scientific Sessions 2022, which were held in Scottsdale, Arizona, between June 2nd and June 5th, 2022.

Recognizing that the presence of nondialysis CKD increases the risk for ASCVD, the researchers compared prescribing practices of statin therapy among patients with ASCVD and nondialysis-dependent stage 4 and stage 5 CKD with those with stage 3a and stage 3b CKD.

The study assessed electronic health records of  patients between 18 and 89 years of age who received treatment within the University of Colorado Health System from January 1, 2020, through September 30, 2021.

The primary study outcome was the proportion of patients with ASCVD who were prescribed high-intensity statin therapy with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m² compared with those with an eGFR ≥30 to 59 mL/min/1.73 m².

Secondary study outcomes included the proportion of patients on a US Food and Drug Administration–approved renal dose adjustment of rosuvastatin, the mean difference in low-density lipoprotein cholesterol levels between the 2 groups, and differences in prescribing patterns of low-intensity to moderate-intensity statins between the 2 groups.

Patients with eGFR <30 mL/min/1.73 m² were found to have a higher mean systolic blood pressure and were more likely to have diabetes or heart failure compared with those with eGFR ≥30 to 59 mL/min/1.73 m². Further, a lower percentage of White individuals was reported in the group with an eGFR <30 mL/min/1.73 m².

No statistically significant differences were observed between the groups with respect to the proportion of high-intensity statins that were prescribed. The researchers found that in 67.6% (25 of 37) of the patients, rosuvastatin was not renally adjusted in an appropriate manner (P =.0240).

The researchers concluded that results of the current study demonstrate that prescribers do not appear to be following the package insert dosing recommendations for rosuvastatin, based on the fact that the severity of a patient’s CKD does not affect the prescribing pattern of high-intensity statin therapy. They recommend identification of prescribing barriers for high-intensity statin therapy and incorporation of these barriers into decision pathways and/or provider education. They also suggest that collaborative drug therapy management with a clinical pharmacist may be beneficial for initiating, titrating, and adjusting high-intensity statin therapy among appropriate patients.

Reference

Fstkchian A, Saseen J, Lowe R. Comparing prescribing practices of statin therapy in ASCVD patients with varying levels of CKD.  Poster presented at: National Lipid Association (NLA) Scientific Sessions 2022; June 2-5, 2022; Scottsdale, Arizona. Abstract #47

This article originally appeared on The Cardiology Advisor