Association of Low‐Density Lipoprotein Cholesterol Levels During Statin Treatment With Cardiovascular and Renal Outcomes in Patients With Moderate Chronic Kidney Disease

BACKGROUND: The benefit of low‐density lipoprotein cholesterol (LDL‐C) levels in chronic kidney disease populations remains unclear. This study evaluated the cardiovascular and renal outcomes in patients with stage 3 chronic kidney disease with different LDL‐C levels during statin treatment. METHODS AND RESULTS: There were 8500 patients newly diagnosed as having stage 3 chronic kidney disease under statin treatment who were identified from the Chang Gung Research Database and divided into 3 groups according to their first LDL‐C level after the index date: <70 mg/dL, 70 to 100 mg/dL, and >100 mg/dL. Inverse probability of treatment weighting was performed to balance baseline characteristics. Compared with the LDL‐C ≥100 mg/dL group, the 70≤LDL‐C<100 mg/dL group exhibited significantly lower risks of major adverse cardiac and cerebrovascular events (6.8% versus 8.8%; subdistribution hazard ratio [SHR], 0.76 [95% CI, 0.64–0.91]), intracerebral hemorrhage (0.23% versus 0.51%; SHR, 0.44 [95% CI, 0.25–0.77]), and new‐onset end‐stage renal disease requiring chronic dialysis (7.6% versus 9.1%; SHR, 0.82 [95% CI, 0.73–0.91]). By contrast, the LDL‐C <70 mg/dL group exhibited a marginally lower risk of major adverse cardiac and cerebrovascular events (7.3% versus 8.8%; SHR, 0.82 [95% CI, 0.65–1.02]) and a significantly lower risk of new‐onset end‐stage renal disease requiring chronic dialysis (7.1% versus 9.1%; SHR, 0.76 [95% CI, 0.67–0.85]). CONCLUSIONS: Among patients with stage 3 chronic kidney disease, statin users with 70≤LDL‐C<100 mg/dL and with LDL‐C <70 mg/dL had similar beneficial effect in the reduction of risks of major adverse cardiac and cerebrovascular events and new‐onset end‐stage renal disease compared with those with LDL‐C >100 mg/dL. Moreover, the 70≤LDL‐C<100 mg/dL group seemed to have a lowest risk of intracerebral hemorrhage, although the incidence was low.