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2015 ; 26
(5
): 1173-80
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Contrasting Cholesterol Management Guidelines for Adults with CKD
#MMPMID25395432
Colantonio LD
; Baber U
; Banach M
; Tanner RM
; Warnock DG
; Gutiérrez OM
; Safford MM
; Wanner C
; Howard G
; Muntner P
J Am Soc Nephrol
2015[May]; 26
(5
): 1173-80
PMID25395432
show ga
The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins
for adults ?50 years old with CKD. The American College of Cardiology/American
Heart Association endorses statins for adults with atherosclerotic cardiovascular
disease, adults with LDL cholesterol?190 mg/dl, and adults 40-79 years old with
LDL cholesterol=70-189 mg/dl and diabetes or a 10-year predicted risk for
atherosclerotic cardiovascular disease ?7.5% estimated using the Pooled Cohort
risk equations. Using data from the Reasons for Geographic and Racial Differences
in Stroke Study, we calculated the agreement for statin treatment between these
two guidelines for adults 50-79 years old with CKD (eGFR<60 ml/min per 1.73 m(2)
or albuminuria?30 mg/g) not on dialysis. We assessed the validity of the Pooled
Cohort risk equations in individuals with CKD. Study participants were enrolled
between 2003 and 2007, and we report incident cardiovascular disease events
(stroke and coronary heart disease) through December of 2010. Among 4726
participants with CKD, 2366 (50%) were taking statins, and 1984 (42%) were
recommended statins by the American College of Cardiology/American Heart
Association guideline but not taking them. Overall, 376 (8%) participants did not
meet the American College of Cardiology/American Heart Association criteria for
initiating statin treatment. Cardiovascular disease incidence was low (3.0/1000
person-years; 95% confidence interval, 0.1 to 5.9) among these participants. The
Pooled Cohort risk equations were well calibrated (Hosmer-Lemeshow
chi-squared=2.7, P=0.45) with moderately good discrimination (C index, 0.71; 95%
confidence interval, 0.65 to 0.77). In conclusion, these guidelines show high
concordance for statin treatment for adults with CKD.