Discussion
nondialysis CKD, ASCVD, CKD, cardiovascular disease
CARDIOVASCULAR DISEASE, EVENT, EVENTS, KIDNEY DISEASE, ASCVD
In this target trial emulation of statin initiation in US veterans older than 65 years with CKD stages 3 to 4 and no prior ASCVD, statin initiation was associated with a lower risk of all-cause mortality but not with MACE. In a less restrictive analysis that included all eligible veterans, results suggested a greater protective association for statins with both all-cause mortality and MACE. These results call into question the growing movement to deprescribe statins for primary prevention in older adults with CKD.Current Kidney Disease Improving Global Outcomes guidelines recommend initiation of statins in older patients with moderate CKD due to the established risk of ASCVD in this population.Our study supports prior literature on the role of statins for primary ASCVD prevention in CKD.Additional post hoc analyses of primary prevention trials focusing on individuals with nondialysis CKD have been mixed. One reported no statistically significant mortality benefit for statins at any stage of CKD,Chronologic age is established as the strongest nonmodifiable risk factor for ASCVD. Coupled with the hyperinflammatory state of CKD,Our study specifically assessed the role of age in addition to CKD level when considering statins for primary prevention. Results were consistent for every age group. The decision to prescribe is multifactorial, and these data support the use of statins for primary prevention for any older adult with CKD.Clinical trials, such as the Statins in Reducing Events in the Elderly (STAREE)This study has several strengths. Our data included linked electronic health record, clinical, and claims data with more than a decade of follow up. Using this large data set, we were able to focus on the role of statins for primary prevention among older adults with CKD stages 3 to 4, a population typically underrepresented in clinical trials. An adequate event rate was ensured due to the overall greater burden of cardiovascular disease among our population of veterans compared with the general population.