Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials

SummaryBackgroundStatin therapy is effective for the prevention of coronary heart disease and stroke in patients with mild-to-moderate chronic kidney disease, but its effects in individuals with more advanced disease, particularly those undergoing dialysis, are uncertain.MethodsWe did a meta-analysis of individual participant data from 28 trials (n=183 419), examining effects of statin-based therapy on major vascular events (major coronary event [non-fatal myocardial infarction or coronary death], stroke, or coronary revascularisation) and cause-specific mortality. Participants were subdivided into categories of estimated glomerular filtration rate (eGFR) at baseline. Treatment effects were estimated with rate ratio (RR) per mmol/L reduction in LDL cholesterol.FindingsOverall, statin-based therapy reduced the risk of a first major vascular event by 21% (RR 0·79, 95% CI 0·77–0·81; p<0·0001) per mmol/L reduction in LDL cholesterol. Smaller relative effects on major vascular events were observed as eGFR declined (p=0·008 for trend; RR 0·78, 99% CI 0·75–0·82 for eGFR ≥60 mL/min per 1·73 m2; 0·76, 0·70–0·81 for eGFR 45 to <60 mL/min per 1·73 m2; 0·85, 0·75–0·96 for eGFR 30 to <45 mL/min per 1·73 m2; 0·85, 0·71–1·02 for eGFR