Scandinavian journal of primary health care · 2026
Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications.
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Malmquist Julia, Davidge Jason, Bjurström Karl, Halling Anders, Agvall Björn
Аннотация
BACKGROUND: Chronic kidney disease (CKD) increases cardiovascular and mortality risk. Guidelines recommend statins for primary prevention in individuals aged ≥50 years with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, but implementation and outcomes remain unclear. This study examined statin use and its association with all-cause mortality in individuals with CKD and no other indication for statin therapy.
METHODS: A retrospective cohort study was conducted using healthcare data derived from Region Halland, Sweden. Adults aged 50-89 years with ≥2 eGFR measurements <60 mL/min/1.73 m2 during 2018-2021 were included, excluding those with prior cardiovascular disease, diabetes, primary hyperlipidemia, dialysis, or kidney transplantation. Follow-up from January 2021 to December 2023 included prevalence of statin use and all-cause mortality. Cox regression estimated adjusted hazard ratios (HR) for mortality, accounting for age, sex, CKD stage, albuminuria, hypertension, and use of statins, renin-angiotensin-aldosterone system (RAASi) inhibitors, and sodium-glucose-cotransporter-2 (SGLT2i) inhibitors.
RESULTS: Among 7,177 individuals (50% women), 38% received statins. Statin use was associated with lower three-year mortality (14% vs. 19%, p < 0.001). Crude mortality rates were 42 vs. 57 deaths per 1,000 person-years. Statin use was associated with reduced mortality risk (HR 0.82, 95% CI:0.72-0.92). Higher age, advanced CKD stage, and hypertension were independently associated with increased mortality. RAASi use was protective (HR 0.31, 95% CI:0.27-0.35).
CONCLUSION: Statin therapy was associated with lower all-cause mortality but was underutilized in adults ≥50 years with CKD. These findings have supported broader implementation of guideline-recommended statin therapy.
METHODS: A retrospective cohort study was conducted using healthcare data derived from Region Halland, Sweden. Adults aged 50-89 years with ≥2 eGFR measurements <60 mL/min/1.73 m2 during 2018-2021 were included, excluding those with prior cardiovascular disease, diabetes, primary hyperlipidemia, dialysis, or kidney transplantation. Follow-up from January 2021 to December 2023 included prevalence of statin use and all-cause mortality. Cox regression estimated adjusted hazard ratios (HR) for mortality, accounting for age, sex, CKD stage, albuminuria, hypertension, and use of statins, renin-angiotensin-aldosterone system (RAASi) inhibitors, and sodium-glucose-cotransporter-2 (SGLT2i) inhibitors.
RESULTS: Among 7,177 individuals (50% women), 38% received statins. Statin use was associated with lower three-year mortality (14% vs. 19%, p < 0.001). Crude mortality rates were 42 vs. 57 deaths per 1,000 person-years. Statin use was associated with reduced mortality risk (HR 0.82, 95% CI:0.72-0.92). Higher age, advanced CKD stage, and hypertension were independently associated with increased mortality. RAASi use was protective (HR 0.31, 95% CI:0.27-0.35).
CONCLUSION: Statin therapy was associated with lower all-cause mortality but was underutilized in adults ≥50 years with CKD. These findings have supported broader implementation of guideline-recommended statin therapy.