Comparing rosuvastatin and atorvastatin on cardiovascular and kidney outcomes in patients with diabetes across chronic kidney disease stages: an emulated target trial in China
Notice bibliographique
Résumé
Background Statins are the cornerstone of lipid-lowering therapies in diabetes and chronic kidney disease (CKD). Rosuvastatin, compared with atorvastatin, is associated with higher risk of kidney impairment in Western populations with diabetes and CKD. However, whether its effects on cardiorenal outcomes can generalise to East Asians remains unknown especially given ethnic differences in statin metabolism. We aimed to compare the risk associations of rosuvastatin versus atorvastatin for cardiovascular-renal outcomes in Chinese people with diabetes across CKD stages. Methods For this target trial emulation, we included a propensity-score overlap-weighted cohort of 106,677 patients (aged 18+ years) with diabetes (type 1 or type 2) in Hong Kong in 2002–2019, comprising 13,737 new-atorvastatin users and 92,940 new-rosuvastatin users. Patients with missing estimated glomerular filtration rate (eGFR) or diagnosed with end-stage kidney disease (ESKD) at baseline, or aged <18 years were excluded. Propensity scores were estimated via multivariate logistic regression based on demographics, clinical characteristics, medication use, and index year. The primary outcome was the incidence of ESKD, defined as dialysis, kidney-replacement therapy, or eGFR <15 ml/min/1.73 m 2 on two occasions (≥90 days apart). We employed Cox-model adjusted for time-fixed and time-varying exposure and covariates to estimate hazard ratios (HRs) for ESKD, major-adverse cardiovascular events (MACE), all-cause mortality, and new-onset albuminuria in the propensity-score overlap-weighted cohort. Follow-up began at the index date (first prescription) and ended at the earliest occurrence of outcomes, death, or Dec 31, 2019. Findings Among 106,677 patients, 75.80% (n = 80,866), 20.47% (n = 21,842), and 3.72% (n = 3969) had CKD stages of G1-2, G3, and G4 respectively. During a median follow-up of 2.33 years, 3.45% (n = 3685) had incident ESKD; 5.78% (n = 6169) reported MACE and 10.13% (n = 10,809) died. Initial (time-fixed) exposure to rosuvastatin was associated with similar risks of ESKD, MACE, and all-cause mortality compared with atorvastatin; whereas, accounting for time-varying exposure revealed a lower risk of MACE (HR = 0.85 [0.77–0.93]) and all-cause mortality (HR = 0.88 [0.81–0.96]) with rosuvastatin. Notably, rosuvastatin was associated with a higher, dose-dependent risk of new-onset albuminuria than atorvastatin in both time-fixed and time-varying Cox models. Interpretation Our findings support similar effects of atorvastatin and rosuvastatin on ESKD, while more favourable cardiovascular effects and dose-dependent association with albuminuria were observed with rosuvastatin in East Asians with diabetes. Careful monitoring for albuminuria is needed in rosuvastatin users, and longer-term studies are required to fully assess the renal safety of rosuvastatin, especially in patients on high-intensity regimens. Funding CUHK Impact Research Fellowship Scheme.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».