Impact of statin on long-term outcome among patients with end-stage renal disease with acute myocardial infarction (AMI): a nationwide case-control study

Statin therapy associated mortality in hyperlipidemic dialysis patients with percutaneous coronary intervention for acute myocardial infarction, a retrospective cohort study

Objective

Hyperlipidemic patients with end-stage renal disease (ESRD) are at a higher risk of death from cardiovascular diseases, especially from acute myocardial infarction (AMI). Studies on the efficacy of statin therapy (ST) in dialysis patients after percutaneous coronary intervention (PCI) are limited. We examine the mortality associated with ST for these patients.

Methods

From dialysis-dependent hyperlipidemic patients with AMI and receiving PCI in the claims data of National Health Insurance of Taiwan in 2000-2016, we identified a cohort with ST and a cohort without ST matched by propensity score at a 1:1 ratio. Both cohorts were followed up until the end of 2017. All-cause mortalities were examined for both cohorts. Other factors associated with the deaths were also examined.

Results

Among 2642 enrollees in each cohort, over 99 % had hypertension. The all-cause mortality was 23 % lower in the ST cohort than in non-ST cohort (10.8 versus 14.0 per 100 person-years) with an adjusted hazard ratio of 0.77(95 % confidence interval = 0.71-0.84). Patients with comorbidities of diabetes, cerebrovascular accident (CVA) and congestive heart failure (CHF) were also at lower risk. The case-control analysis in the ST cohort showed the estimated risk of death increased with age, and higher for females and patients with peripheral artery disease.

Conclusions

The ST for hyperlipidemic patients with ESRD experiencing AMI undergoing PCI could be benefited with lower all-cause mortality, even for patients with diabetes, hypertension, CVA or CHF.

Association of diverticulitis and potential risk of ischemic stroke: population-based matched cohort study in Taiwan

BACKGROUND

Previous studies have suggested relationship between diverticular disease and cardiovascular disease. Since cardiovascular disease and cerebrovascular accident share a lot of pathogenesis, diverticulitis could also be a risk factor for stroke. This study tried to establish epidemiological evidence of the relationship between colon diverticulitis and ischemic stroke.

METHODS

In this retrospective cohort study, patients with newly diagnosed colon diverticulitis (N = 6238) and patients without colon diverticulitis (control group; N = 24 952) were recruited between January 1, 2000, and December 31, 2017. Both groups were matched by propensity score at a 1:4 ratio by age, sex, comorbidities and medications. Cox proportional hazard regression was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) of ischemic stroke. We also conducted 4 different regression models and 2 sensitivity analyses to test the robustness of our findings.

RESULTS

The diverticulitis group had a higher risk of IS than the control group (adjusted HR, 1.25; 95% CI, 1.12-1.39; P < 0.001). Serial sensitivity analyses yielded consistent positive link between diverticulitis and IS. Further subgroup analysis showed that in the study group, the risk of IS was 2.54-fold higher than the matched controls in 30-39 years.

CONCLUSIONS

Our study found that colon diverticulitis was associated with a higher risk of developing subsequent ischemic stroke, especially for patients aged 30-39 years, among Asian population. This result provides us a chance to undertake preventive measures for ischemic stroke in high-risk patients.

Association between statin therapy and mortality in patients on dialysis after atherosclerotic cardiovascular diseases

Statin therapy is essential for secondary prevention in patients with atherosclerotic cardiovascular disease (ASCVD). However, the effects of statin therapy in patients receiving chronic dialysis remain uncertain. We aimed to evaluate the effect of statin therapy on long-term mortality in patients on dialysis after a first-time ASCVD. Patients receiving maintenance dialysis aged ≥ 18 years with a first-time ASCVD event between 2013 and 2018 were included in the Korean National Health Insurance Service database. Associations of statin use with long-term mortality were examined using Cox proportional hazards regression models adjusted for demographics and comorbidities. Among 17,242 patients on dialysis, 9611 (55.7%) were prescribed statins after a first-time ASCVD event. Among statin users, 7376 (76.7%) used moderate-intensity statins. During a mean follow-up of 32.6 ± 20.9 months, statin use was associated with a lower risk of all-cause mortality than statin nonuse after adjusting for confounding factors (hazard ratio [HR]: 0.92; 95% confidence interval [CI] 0.88-0.97; p = 0.0009). Despite a lack of evidence, more than half of patients on dialysis were prescribed statins after an ASCVD event. In patients on dialysis after ASCVD, statin therapy significantly reduced the risk of long-term all-cause mortality.