title: Comparative Effectiveness of Statin Therapy in Chronic Kidney Disease and Acute Myocardial Infarction: A Retrospective Cohort Study.
abstract: BACKGROUND
  Whether there is a kidney function threshold to statin effectiveness in patients with acute myocardial infarction is poorly understood. Our study sought to help fill this gap in clinical knowledge.
  
  
  METHODS
  We undertook a new-user cohort study of the effectiveness of statin therapy by level of estimated glomerular filtration rate (eGFR) in adults who were hospitalized for myocardial infarction between 2000 and 2008. Data came from the Cardiovascular Research Network. The primary clinical outcomes were 1-year all-cause mortality and cardiovascular hospitalizations, with adverse outcomes of myopathy and development of diabetes mellitus. We calculated incidence rates, the number needed to treat, and used Cox proportional hazards regression with propensity score matching and adjustment to control for confounding, with testing for variation of effect by level of kidney function.
  
  
  RESULTS
  Compared with statin non-initiators (n = 5583), statin initiators (n = 5597) had a lower propensity score-adjusted risk for death (hazard ratio 0.79; 95% confidence interval [CI], 0.71-0.88) and cardiovascular hospitalizations (hazard ratio 0.90; 95% CI, 0.82-1.00). We found little evidence of variation in effect by level of eGFR (P = .86 for death; P = .77 for cardiovascular hospitalization). Adverse outcomes were similar for statin initiators and statin non-initiators. The number needed to treat to prevent 1 additional death over 1 year of follow-up ranged from 15 (95% CI, 11-28) for eGFR <30 mL/min/1.73 m(2) requiring statin treatment over 2 years to prevent 1 additional death, to 67 (95% CI, 49-118) for patients with eGFR >90 mL/min/1.73 m(2).
  
  
  CONCLUSIONS
  Our findings suggest that there is potential for important public health gains by increasing the routine use of statin therapy for patients with lower levels of kidney function.
authors.affiliation: Kaiser Permanente Center for Health Research - Northwest, Portland, Ore. Electronic address: David.H.Smith@kpchr.org.
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.affiliation: Kaiser Permanente Center for Health Research - Northwest, Portland, Ore.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Johnson
authors.affiliation: Group Health Research Institute, Seattle, Wash.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
authors.affiliation: Henry Ford Hospital, Detroit, Mich.
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Cassidy-Bushrow
authors.affiliation: Kaiser Permanente Center for Health Research - Northwest, Portland, Ore.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fortmann
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, Wis.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Greenlee
authors.affiliation: Meyers Primary Care Institute, Worcester, Mass; Fallon Community Health Plan, Worcester, Mass; University of Massachusetts, Worcester.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Kaiser Permanente Institute for Health Research, Denver, Colo; University of Colorado Health Sciences Center, Denver.
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.affiliation: Baylor Scott & White Center for Applied Health Research, Temple, Tex; Texas A&M Health Science Center, Round Rock.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: McNeal
authors.affiliation: Kaiser Permanente Department of Research & Evaluation, Pasadena, Calif.
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.affiliation: Geisinger Clinic, Danville, Pa.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Steinhubl
authors.affiliation: Kaiser Permanente Center for Health Research - Northwest, Portland, Ore.
authors.forename: Micah
authors.initials: M
authors.lastname: Thorp
authors.affiliation: Kaiser Permanente Center for Health Research - Hawaii, Honolulu.
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Tom
authors.affiliation: Mid-Atlantic Permanente Research Institute, Rockville, Md.
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.affiliation: Marshfield Clinic Research Foundation, Marshfield, Wis.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: VanWormer
authors.affiliation: Kaiser Permanente Center for Health Research - Northwest, Portland, Ore.
authors.forename: Jessica
authors.initials: J
authors.lastname: Weinstein
authors.affiliation: Kaiser Permanente Center for Health Research - Northwest, Portland, Ore.
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Yang
authors.affiliation: Kaiser Permanente Division of Research, Oakland, Calif; University of California, San Francisco.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Kaiser Permanente Division of Research, Oakland, Calif.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sidney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Chronic kidney disease; Comparative effectiveness; Statins; eGFR