Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications
Malmquist, Julia ; Davidge, Jason LU ; Bjurström, Karl ; Halling, Anders LU and Agvall, Björn LU
(2026)
In Scandinavian Journal of Primary Health Care
44(1).
- Abstract
BACKGROUND: Chronic kidney disease (CKD) increases cardiovascular and mortality risk. Guidelines recommend statins for primary prevention in individuals aged ≥50 years with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, but implementation and outcomes remain unclear. This study examined statin use and its association with all-cause mortality in individuals with CKD and no other indication for statin therapy.
METHODS: A retrospective cohort study was conducted using healthcare data derived from Region Halland, Sweden. Adults aged 50-89 years with ≥2 eGFR measurements <60 mL/min/1.73 m2 during 2018-2021 were included, excluding those with prior cardiovascular disease, diabetes, primary hyperlipidemia,... (More)
BACKGROUND: Chronic kidney disease (CKD) increases cardiovascular and mortality risk. Guidelines recommend statins for primary prevention in individuals aged ≥50 years with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, but implementation and outcomes remain unclear. This study examined statin use and its association with all-cause mortality in individuals with CKD and no other indication for statin therapy.
METHODS: A retrospective cohort study was conducted using healthcare data derived from Region Halland, Sweden. Adults aged 50-89 years with ≥2 eGFR measurements <60 mL/min/1.73 m2 during 2018-2021 were included, excluding those with prior cardiovascular disease, diabetes, primary hyperlipidemia, dialysis, or kidney transplantation. Follow-up from January 2021 to December 2023 included prevalence of statin use and all-cause mortality. Cox regression estimated adjusted hazard ratios (HR) for mortality, accounting for age, sex, CKD stage, albuminuria, hypertension, and use of statins, renin-angiotensin-aldosterone system (RAASi) inhibitors, and sodium-glucose-cotransporter-2 (SGLT2i) inhibitors.
RESULTS: Among 7,177 individuals (50% women), 38% received statins. Statin use was associated with lower three-year mortality (14% vs. 19%, p < 0.001). Crude mortality rates were 42 vs. 57 deaths per 1,000 person-years. Statin use was associated with reduced mortality risk (HR 0.82, 95% CI:0.72-0.92). Higher age, advanced CKD stage, and hypertension were independently associated with increased mortality. RAASi use was protective (HR 0.31, 95% CI:0.27-0.35).
CONCLUSION: Statin therapy was associated with lower all-cause mortality but was underutilized in adults ≥50 years with CKD. These findings have supported broader implementation of guideline-recommended statin therapy.
(Less)
- author
- Malmquist, Julia
; Davidge, Jason
LU
; Bjurström, Karl
; Halling, Anders
LU
and Agvall, Björn
LU
- organization
- publishing date
- 2026-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use, Renal Insufficiency, Chronic/mortality, Aged, Middle Aged, Female, Male, Primary Prevention, Retrospective Studies, Aged, 80 and over, Glomerular Filtration Rate, Sweden/epidemiology, Cardiovascular Diseases/prevention & control, Proportional Hazards Models
- in
- Scandinavian Journal of Primary Health Care
- volume
- 44
- issue
- 1
- article number
- 2636586
- publisher
- Informa Healthcare
- external identifiers
-
- scopus:105031644108
- pmid:41769754
- ISSN
- 0281-3432
- DOI
- 10.1080/02813432.2026.2636586
- language
- English
- LU publication?
- yes
- id
- 80046268-c325-4875-b57b-a802fe90b6bc
- date added to LUP
- 2026-08-24 08:32:36
- date last changed
- 2026-09-08 04:47:07
@article{80046268-c325-4875-b57b-a802fe90b6bc,
abstract = {{<p>BACKGROUND: Chronic kidney disease (CKD) increases cardiovascular and mortality risk. Guidelines recommend statins for primary prevention in individuals aged ≥50 years with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, but implementation and outcomes remain unclear. This study examined statin use and its association with all-cause mortality in individuals with CKD and no other indication for statin therapy.</p><p>METHODS: A retrospective cohort study was conducted using healthcare data derived from Region Halland, Sweden. Adults aged 50-89 years with ≥2 eGFR measurements <60 mL/min/1.73 m2 during 2018-2021 were included, excluding those with prior cardiovascular disease, diabetes, primary hyperlipidemia, dialysis, or kidney transplantation. Follow-up from January 2021 to December 2023 included prevalence of statin use and all-cause mortality. Cox regression estimated adjusted hazard ratios (HR) for mortality, accounting for age, sex, CKD stage, albuminuria, hypertension, and use of statins, renin-angiotensin-aldosterone system (RAASi) inhibitors, and sodium-glucose-cotransporter-2 (SGLT2i) inhibitors.</p><p>RESULTS: Among 7,177 individuals (50% women), 38% received statins. Statin use was associated with lower three-year mortality (14% vs. 19%, p < 0.001). Crude mortality rates were 42 vs. 57 deaths per 1,000 person-years. Statin use was associated with reduced mortality risk (HR 0.82, 95% CI:0.72-0.92). Higher age, advanced CKD stage, and hypertension were independently associated with increased mortality. RAASi use was protective (HR 0.31, 95% CI:0.27-0.35).</p><p>CONCLUSION: Statin therapy was associated with lower all-cause mortality but was underutilized in adults ≥50 years with CKD. These findings have supported broader implementation of guideline-recommended statin therapy.</p>}},
author = {{Malmquist, Julia and Davidge, Jason and Bjurström, Karl and Halling, Anders and Agvall, Björn}},
issn = {{0281-3432}},
keywords = {{Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use; Renal Insufficiency, Chronic/mortality; Aged; Middle Aged; Female; Male; Primary Prevention; Retrospective Studies; Aged, 80 and over; Glomerular Filtration Rate; Sweden/epidemiology; Cardiovascular Diseases/prevention & control; Proportional Hazards Models}},
language = {{eng}},
number = {{1}},
publisher = {{Informa Healthcare}},
series = {{Scandinavian Journal of Primary Health Care}},
title = {{Association between statin therapy as primary prevention and mortality in adults 50 years and older with chronic kidney disease without other indications}},
url = {{http://dx.doi.org/10.1080/02813432.2026.2636586}},
doi = {{10.1080/02813432.2026.2636586}},
volume = {{44}},
year = {{2026}},
}