title: Low utilization of secondary preventive medications and its potential impact in patients with chronic kidney disease and acute coronary syndromes.
abstract: BACKGROUND
  An estimated 11% of the population of the USA has chronic kidney disease. Cardiovascular morbidity and mortality are high among these individuals. We evaluated the impact of evidence-based, secondary preventive medications on the overall clinical outcome among this population.
  
  
  METHODS
  We observed 2,627 consecutive patients admitted to our institution for acute coronary syndrome. The glomerular filtration rate was estimated by the four-component Modification of Diet in Renal Disease equation and the patients were stratified into groups on the basis of the guidelines of the National Kidney Foundation. Mortality and the composite event rate of death, myocardial infarction and stroke were assessed at six months. We evaluated the impact of evidence-based medications as an independent predictor of outcomes, using a logistic regression analysis. RESULTS- Patients with a relatively greater decline in the glomerular filtration rate had poorer outcomes, both in hospital and at six-month follow-up. Among those with stages III-V of chronic kidney disease, the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) was associated with 44% lower odds of death (95% CI: 0.14-0.63), as well as 40% lower odds of the composite end-point (95% CI: 0.13-0.59) at six months.
  
  
  CONCLUSIONS
  Chronic kidney disease was independently associated with mortality and major adverse cardiovascular events in a hospital registry of consecutive patients with acute coronary syndrome. Our results add to the existing body of evidence that more appropriate use of evidence-based medications, particularly statins, may significantly improve clinical outcomes in these highndash;risk patients. We should aim to improve the quality of treatment options available to patients suffering from both conditions.
authors.affiliation: Stanford University, Stanford, California, USA.
authors.forename: Randall K
authors.initials: RK
authors.lastname: Harada
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.forename: Eva M
authors.initials: EM
authors.lastname: Kline-Rogers
authors.forename: Jianming
authors.initials: J
authors.lastname: Fang
authors.forename: Dean
authors.initials: D
authors.lastname: Smith
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee