Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials

Herrington, William G.; Emberson, Jonathan; Mihaylova, Borislava; Blackwell, Lisa; Reith, Christina; Solbu, Marit Dahl; Mark, Patrick B.; Fellström, Bengt; Jardine, Alan G.; Wanner, Christoph; Holdaas, Hallvard; Fulcher, Jordan; Haynes, Richard; Landray, Martin J; Keech, Anthony; Simes, John; Collins, Rory; Baigent, Colin

doi:10.1016/s2213-8587(16)30156-5

Cited by 258 publications

(117 citation statements)

References 63 publications

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“…Studies have indicated that long-term use of statins can improve the initial clinical symptoms of ACS patients and reduce the incidence of ST segment elevation myocardial infarction1415. Different retrospective studies and meta-analysis have shown that for patients undergoing elective PCI, statin therapy can effectively reduce the incidence of postoperative PMI161718. A large number of studies have shown that, in addition to stable plaque, statins can improve endothelial function and anti-inflammatory and improve the vascular wall inflammation induced by PCI.…”

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confidence: 99%

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

2017

Sci Rep

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Many scholars have studied the effect of nicorandil on perioperative myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI), but results are inconsistent. Therefore, we performed this meta-analysis. Finally, 16 articles, including 1616 patients, were included into this meta-analysis. Meta-analysis results showed that: (1) Nicorandil can reduce the level of CK-MB after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (2) Nicorandil can reduce the level of TnT after PCI, including at 6 hours, 12 hours, 18 hours and 24 hours. (3) Nicorandil can reduce the incidence of adverse reactions after PCI. (4) Nicorandil cannot reduce the level of MVP after PCI, including at 12 hours and 24 hours. (5) Subgroup analysis showed that nicorandil can reduce CK-MB and TnT level at 24 hours after PCI for Chinese’s population (P < 0.05), but can not reduce CK-MB and TnT level at 24 hours after PCI for non Chinese’s population (P > 0.05). Our meta-analysis indicate that nicorandil can reduce myocardial injury and reduce the incidence of adverse reaction caused by PCI for Chinese’s population, but is not obvious for non Chinese’s population. However, this conclusion still needs to be confirmed in the future.

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confidence: 99%

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

2017

Sci Rep

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“…Highly credible evidence from RCTs also showed that statin use was associated with lower all-cause mortality in CKD patients not on dialysis, but the association was not significant in patients undergoing dialysis. An individual patient data meta-analysis also showed that there were trends for relatively smaller cardiovascular and all-cause mortality benefits of statins as eGFR declined [53]. The benefit of statin use in CKD patients not on dialysis was also acknowledged by current guidelines [11,54,55].…”

Section: Discussionmentioning

confidence: 98%

Clinical Interventions and All-Cause Mortality of Patients with Chronic Kidney Disease: An Umbrella Systematic Review of Meta-Analyses

Kim

Steingroever

Lee

et al. 2020

JCM

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Patients with chronic kidney disease (CKD) have altered physiologic processes, which result in different treatment outcomes compared with the general population. We aimed to systematically evaluate the efficacy of clinical interventions in reducing mortality of patients with CKD. We searched PubMed, MEDLINE, Embase, and Cochrane Database of Systematic Reviews for meta-analyses of randomized controlled trials (RCT) or observational studies (OS) studying the effect of treatment on all-cause mortality of patients with CKD. The credibility assessment was based on the random-effects summary estimate, heterogeneity, 95% prediction intervals, small study effects, excess significance, and credibility ceilings. Ninety-two articles yielded 130 unique meta-analyses. Convincing evidence from OSs supported mortality reduction with three treatments: angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers for patients not undergoing dialysis, warfarin for patients with atrial fibrillation not undergoing dialysis, and (at short-term) percutaneous coronary intervention compared to coronary artery bypass grafting for dialysis patients. Two treatment comparisons were supported by highly credible evidence from RCTs in terms of all-cause mortality. These were high-flux hemodialysis (HD) versus low-flux HD as a maintenance HD method and statin versus less statin or placebo for patients not undergoing dialysis. Most significant associations identified in OSs failed to be replicated in RCTs. Associations of high credibility from RCTs were in line with current guidelines. Given the heterogeneity of CKD, it seems hard to assume mortality reductions based on findings from OSs.

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“…On the one hand, meta-analyses [14, 36] have shown that lowering LDL-C with statin therapy could effectively reduce vascular risk among patients with mild-to-moderate CKD and delay the progress of CKD. On the other hand, the pleiotropic effects of statins [37-39], which included reducing free radical levels, increasing endothelial nitric oxide synthase levels and inhibiting the activity of excitotoxic amino acids and the production of inflammatory mediators, could also decrease common risk factors of CKD and cerebrovascular diseases [40] (e.g., oxidative stress and inflammation).…”

Section: Discussionmentioning

confidence: 99%

“…Statins are also recommended for the primary and secondary prevention of cerebrovascular diseases [8, 9]. Recently, many studies focused on the efficiency of statin use in patients with CKD [10-14]. Previous studies showed that statin use had a relationship with decreased mortality of patients with myocardial infarction (MI) and mild-to-severe renal insufficiency for secondary prevention [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Statin Use during Hospitalization and Short-Term Mortality in Acute Ischaemic Stroke with Chronic Kidney Disease

et al. 2018

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Objectives: Statin use during hospitalization improves prognosis in patients with ischaemic stroke. However, it remains uncertain whether acute ischaemic stroke patients with chronic kidney disease (CKD) benefit from statin therapy. We investigated the effect of statin use during hospitalization in reducing short-term mortality of patients with ischaemic stroke and CKD. Methods: Data of first-ever ischaemic stroke patients without a history of pre-stroke statin treatment was derived from the China National Stroke Registry. Patients were stratified according to estimated glomerular filtration rate (eGFR): normal renal function (eGFR ≥90 mL/min/1.73 m²), mild CKD (eGFR 60–90 mL/min/1.73 m²) and moderate CKD (eGFR < 60 mL/min/1.73 m²). Multivariate logistic regression analysis was used to evaluate the association between statin use during hospitalization and all-cause mortality with different renal functions at 3-month follow-up. Results: Among 5,951 patients included, 2,595 (43.6%) patients were on statin use during hospitalization after stroke (45.7% in patients with normal renal function, 42.0% in patients with mild CKD, and 39.0% in patients with moderate CKD). Compared with the non-statin group, statin use during hospitalization was associated with decreased all-cause mortality in patients with normal renal function (OR 0.65, 95% CI 0.43–0.97, p = 0.04), mild CKD (OR 0.59, 95% CI 0.38–0.91, p = 0.02) and moderate CKD (OR 0.41, 95% CI 0.23–0.75, p = 0.004) at 3-month follow-up. Conclusions: Statin use during hospitalization was associated with decreased 3-month mortality of ischaemic stroke patients with mild and moderate CKD. However, the conclusion should be confirmed in further studies with larger population, especially with moderate CKD.

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Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials

Abstract: UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Community Biomed Programme, Australian National Health and Medical Research Council, Australian National Heart Foundation.

Cited by 258 publications

References 63 publications

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

The clinical effect of nicorandil on perioperative myocardial protection in patients undergoing elective PCI: A Systematic Review and Meta-Analysis

Clinical Interventions and All-Cause Mortality of Patients with Chronic Kidney Disease: An Umbrella Systematic Review of Meta-Analyses

Statin Use during Hospitalization and Short-Term Mortality in Acute Ischaemic Stroke with Chronic Kidney Disease

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