title: Statins and renovascular disease in the elderly: a population-based cohort study.
abstract: OBJECTIVE
  More than 90% of cases of renovascular disease (RVD) are caused by atherosclerosis; thus patients with this condition are at high risk for vascular events. We examined the association of statins with prognosis in patients with RVD.
  
  
  RESULTS
  We performed a population-based cohort study in 4040 patients with RVD older than 65 years using province-wide health data in Ontario, Canada. The primary outcome was time to first cardiorenal event, specifically myocardial infarction, stroke, heart failure, acute renal failure, dialysis or death; the primary analysis used a time-dependent covariate for statin exposure. Despite having a greater burden of cardiovascular and renal comorbidity, the risk of the primary outcome was significantly lower in statin users than in non-users [unadjusted hazard ratio (HR) 0.51, 95% confidence interval (CI) 0.47-0.57; P < 0.0001]. This association was materially unchanged after adjusting for demographic characteristics, cardiovascular risk factors, other comorbidities, measures of health-care utilization, screening, and concomitant medications (adjusted HR 0.51, 95% CI 0.46-0.57). An analysis using the same endpoint in a propensity-matched cohort without time-dependent statin exposure revealed a lower risk of the primary outcome in statin-treated patients but with a substantially more conservative point estimate (HR 0.82, 95% CI 0.71-0.95).
  
  
  CONCLUSIONS
  These data suggest that statins are associated with improved prognosis in elderly patients with RVD.
authors.affiliation: Stroke Prevention and Atherosclerosis Research Centre, University of Western Ontario, Siebens Drake Research Institute, London, Ontario, Canada. dhackam@uwo.ca
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Hackam
authors.forename: Fangyun
authors.initials: F
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Sheldon W
authors.initials: SW
authors.lastname: Tobe
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D009864:Ontario / Q000453:epidemiology; D011379:Prognosis; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D016019:Survival Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors