title: Statins of high versus low cholesterol-lowering efficacy and the development of severe renal failure.
abstract: BACKGROUND
  The objective of this nationwide retrospective cohort study was to examine the renal outcomes of HMG-CoA reductase inhibitor (statin) initiators.
  
  
  METHODS
  The patients who started to take statins with high cholesterol-lowering efficacy (atorvastatin and rosuvastatin) and low efficacy (lovastatin, simvastatin, pravastatin, and fluvastatin) between 1 January 2001 and 31 December 2008 were identified from the Taiwan National Health Insurance claims database. The outcome of interest was severe renal failure, defined as the composite endpoint of hemodialysis, peritoneal dialysis, and kidney transplantation. A proportional hazard regression model was applied to estimate the incidence ratio between the two groups, adjusted for the propensity scores based upon baseline characteristics.
  
  
  RESULTS
  Among of the 26,007 and 42,249 statin initiators, the crude incidence rate for developing severe renal failure was 0.65 and 0.46 per 100 person-years for the high-efficacy and low-efficacy groups, respectively. Despite that these two groups had comparable risk for myocardial infarction (hazard ratio: 1.06, 95%CI: 0.92–1.21), there was a 13% increased hazard for developing severe renal failure in the rosuvastatin and atorvastatin initiators (hazard ratio: 1.13, 95%CI: 1.02–1.26). The increased risk associated with these two statins was consistent across different risk groups (diabetes, chronic kidney disease, and ischemic heart disease).
  
  
  CONCLUSIONS
  Statins with high cholesterol-lowering efficacy might increase the risk for developing severe renal failure. An alternative explanation is that the renal risk cannot be ameliorated as much as cardiovascular risk. Further follow-up studies or meta-analyses are needed to solve the controversy.
authors.forename: Yu-Heng
authors.initials: YH
authors.lastname: Chung
authors.forename: Yen-Chieh
authors.initials: YC
authors.lastname: Lee
authors.forename: Chia-Hsuin
authors.initials: CH
authors.lastname: Chang
authors.forename: Min-Shung
authors.initials: MS
authors.lastname: Lin
authors.forename: Jou-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Mei-Shu
authors.initials: MS
authors.lastname: Lai
mesh_terms: D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D007677:Kidney Function Tests; D008297:Male; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors