A new analysis concludes that large numbers of patients in advanced stages of kidney disease are inappropriately being prescribed statins to lower their cholesterol -- drugs that offer them no benefit and may increase other health risks such as diabetes, dementia or muscle pain.
The findings, which were published in the American Journal of Cardiovascular Drugs as a review of multiple studies, raise serious questions about the value of cholesterol-lowering therapies in kidney disease.
The issue is important, the researchers say, because the incidence of chronic kidney disease is rising in the United States at what they called "an alarming rate." Also, kidney disease patients are 23 times more likely to get cardiovascular disease, and for them it's the leading cause of death.
But for these patients, the frequent decision to prescribe statin drugs to lower cholesterol in order to reduce the risk of cardiovascular disease is not supported by the wider body of research, experts say.
"There is very little benefit to statin drugs for patients in the early stages of kidney disease, and no benefit or possible toxicity for patients in later stages," said Ali Olyaei, a professor of pharmacotherapy in the College of Pharmacy at Oregon State University, and lead author on the new report.
"I believe the evidence shows that the majority of people with chronic kidney disease are taking statins inappropriately," Olyaei said. "They may help a little in early-stage disease, but those people are not the ones who generally die from cardiovascular diseases. And by the end stages the risks outweigh any benefit. More drugs are not always better."
Some of the particular risks posed by statin use, especially at higher doses, include severe muscle pain known as rhabdomyolysis, an increase in dementia and a significant increase in the risk of developing diabetes. The body of research also shows that statins do nothing to slow the progression of kidney disease, contrary to some reports that it might.
The impetus to use statin drugs -- some of the most widely prescribed medications in the world to lower cholesterol -- is obvious in end-stage kidney disease, because those patients have a mortality rate from coronary heart disease 15 times that of the general population. Unfortunately, evidence shows the drugs do not help prevent mortality in that situation. There is also no proven efficacy of the value of statins in patients using dialysis, researchers said.
If statins are prescribed in early-stage kidney disease, the study concluded that low dosages are more appropriate.
- A. Olyaei, J. L. Steffl, J. MacLaughlan, M. Trabolsi, S. P. Quadri, I. Abbasi, E. Lerma. HMG-CoA Reductase Inhibitors in Chronic Kidney Disease. American Journal of Cardiovascular Drugs, 2013; DOI: 10.1007/s40256-013-0041-4
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