Open AccessUse of lipid‐lowering therapies in patients with chronic kidney disease and atherosclerotic cardiovascular disease: 2‐year results from G etting to an impr O ved U nderstanding of L ow‐ D ensity lipoprotein cholesterol and dyslipidemia management ( GOULD )
Author(s) -
Shaik Aleesha,
Kosiborod Mikhail,
Lemos James A.,
Gao Qi,
Mues Katherine E.,
Alam Shushama,
Bhatt Deepak L.,
Can Christopher P.,
Ballantyne Christie M.,
Rosenson Robert S.
Publication year - 2022
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23923
Subject(s) - medicine , ezetimibe , kidney disease , statin , dyslipidemia , population , discontinuation , pcsk9 , endocrinology , cholesterol , disease , lipoprotein , ldl receptor , environmental health
Background Chronic kidney disease (CKD) is a known risk factor of atherosclerotic cardiovascular disease (ASCVD). Per the 2018 American Heart Association/American College of Cardiology cholesterol guidelines, high‐risk ASCVD patients with CKD and low‐density lipoprotein cholesterol (LDL‐C) levels ≥ $\ge $ 70 mg/dL should take a high‐intensity statin with ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). Objective/Methods We examined the changes in use of lipid lowering therapies (LLT) over two years in 3304 patients with ASCVD and CKD in the G etting to an impr O ved U nderstanding of L ow‐ D ensity Lipoprotein Cholesterol and Dyslipidemia Management ( GOULD ) observational cohort study. Results Of those with eGFR <60 ml/min/1.73 m 2 , 21.6% (171/791) had intensification of LLT while 10.4% (82/791) had de‐escalation of LLT. Notably, 61.6% (487/791) had no change in LLT regimen over 2 years. Statin use was 83.2% (785/944) at baseline and 80.1% (634/791) at 2 years. Statin/ezetimibe use increased from 2.9% (27/944) to 4.9% (39/791). Statin discontinuation at 2 years was greater with lower eGFR levels across all cohorts. Conclusion Despite the recommendations of multiscociety guidelines, statin use, while high, is not ubiquitous and rates of high‐intensity statin and ezetimibe use remain low in patients with CKD. There remains a significant opportunity to optimize LLT and achieve atheroprotective cholesterol levels in the CKD population.