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Abstract: ASN Annual Meeting -- San Francisco |
Sozio S, Coresh J, Jaar B, et al.
Statins Do Not Increase Stroke Risk in Patients Initiating Dialysis: The Choices for Healthy Outcomes in Caring for End Stage Renal Disease (CHOICE) Study.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:708A 2007
In the 4D trial, there was an unexpected higher rate of stroke among those treated with HMG-CoA reductase inhibitors (statins) than placebo among prevalent diabetic hemodialysis patients. It is not known if this was a type I error or a true association. We investigated the association of statin use at baseline and cerebrovascular disease (CVA) among a national, incident dialysis cohort of 1,041 patients enrolled from 10/95 to 7/98. Incident CVA was defined as both non fatal (hospitalized stroke, carotid endarterectomy) and fatal (stroke death) events after dialysis initiation. Participants were censored for transplant, non-stroke death, lost to follow-up, or at 12/31/04.
With Cox proportional hazards regression analysis, we assessed the independent risk of CVA associated with statin use after adjustment in separate models for a propensity to use statins score and for age, race, sex, history of CVA, smoking status, diabetes, hypertension, albumin, and cholesterol. Mean age was 58 years with 54% male, 67% White, 74% on hemodialysis, and 16% taking statins.
A total of 165 patients experienced a CVA; incidence rate was 5.2 per 100 person-years (95% CI [3.4- 7.6]) for those taking statins and 4.8 per 100 person-years (95% CI [4.1- 5.7]) for non-statin users. Statin use was not associated with increased hazard of CVA in univariate, propensity adjusted, or traditional multivariate analyses (Table).
Relative Hazard (95% CI) of CVA by Statin Use Unadjusted Model 1 Model 2 Statin Use 1.08 (0.73-1.61) 0.97 (0.62-1.51) 0.88 (0.56-1.38) Model 1: Adjusted for deciles of propensity score;
Model 2: Adjusted for age, race, sex, history of CVA, smoking status, diabetes, hypertension, albumin, cholesterol
© Copyright 2007-2008, American Society of Nephrology. Reproduced with permission.
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