title: Statins and Cardiovascular Primary Prevention in CKD: A Meta-Analysis.
abstract: OBJECTIVE
  Multiple meta-analyses of lipid-lowering therapies for cardiovascular primary prevention in the general population have been performed. Other meta-analyses of lipid-lowering therapies in CKD have also been performed, but not for primary prevention. This meta-analysis assesses lipid-lowering therapies for cardiovascular primary prevention in CKD.
  
  
  METHODS
  A systematic review and meta-analysis using a random-effects model was performed. MEDLINE was searched between January 2012 and September 2013 for new studies using predefined search criteria without language restrictions. A number of other sources including previously published meta-analyses were also reviewed. Inclusion criteria were randomized control trials of primary prevention with lipid-lowering therapy in non-end stage CKD.
  
  
  RESULTS
  Six trials were identified, five including patients with stage 3 CKD only. These studies included 8834 participants and 32,846 person-years of follow-up. All trials were post hoc subgroup analyses of statins in the general population. Statins reduced the risk of cardiovascular disease (the prespecified primary outcome) by 41% in stages 1-3 CKD compared with placebo (pooled risk ratio, 0.59; 95% confidence interval [95% CI], 0.48 to 0.72). For the secondary outcomes, the risk ratios were 0.66 (95% CI, 0.49 to 0.88) for total mortality, 0.55 (95% CI, 0.42 to 0.72) for coronary heart disease events, and 0.56 (95% CI, 0.28 to 1.13) for stroke. In study participants with stage 3 CKD specifically, the results were similar.
  
  
  CONCLUSIONS
  This meta-analysis suggests that the use of statins in CKD for primary prevention of cardiovascular disease is effective. These findings are consistent with recent guidance for the use of statins in all patients with CKD.
authors.affiliation: The John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom; and Departments of Health Sciences, and rm157@le.ac.uk.
authors.forename: Rupert W
authors.initials: RW
authors.lastname: Major
authors.affiliation: Infection, Immunity, and Inflammation, University of Leicester, Leicester, United Kingdom The John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom; and.
authors.forename: Chee Kay
authors.initials: CK
authors.lastname: Cheung
authors.affiliation: Departments of Health Sciences, and.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Gray
authors.affiliation: Infection, Immunity, and Inflammation, University of Leicester, Leicester, United Kingdom The John Walls Renal Unit, Leicester General Hospital, Leicester, United Kingdom; and.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Brunskill
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D003327:Coronary Disease / Q000517:prevention & control; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D020521:Stroke / Q000517:prevention & control
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: CKD; cardiovascular disease; statins
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