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High potency statins 'linked with increased risk of acute kidney injury'

Patients started on a high potency statin prescription are more likely to be hospitalised with acute kidney injury, say researchers.

The study

Healthcare databases in Canada, UK and the US were used to gather data on 2,067,639 new statin users, defined as those who were prescribed a statin, but had no cholesterol lowering drug or prescription for niacin in the previous 365 days. High potency statin treatment was defined as at least 10mg rosuvastatin, at least 20mg atorvastatin, and at least 40mg simvastatin.

The findings

Patients who started high potency statins were 34% more likely to be hospitalised for acute kidney injury than those who started low potency statins, over the first 120 days of treatment, although this reduced to 11% when looking at 120 to 365 days post-therapy initiation. There was no significant difference in the rates of hospitalisation between those with chronic kidney disease and those with non-chronic kidney disease taking statins.

What does it mean for GPs?

The Canadian researchers concluded that ‘prescribers should consider the increased risk when contemplating use of high potency statins in clinical practice, particularly when treatment with a low potency statin is an option,’ adding that ‘a pressing question is how to identify patients for whom the risk-benefit balance for high potency statin treatment is unfavourable

BMJ 2013, online 20 March

Readers' comments (2)

  • Vinci Ho

    This brings back the argument of whether one is using statin as a modifier for endothelial dysfunction where a low dose will suffice disregarding what the LDL or HDL are , for instance. Then perhaps even a low dose is enough. A bit like the old story of aspirin , 75 , 150 or 300mg ?
    Then again in those with familial hyperlipidaemia where all lipids could be extremely high , one would have no choice but go for higher doses. More research is needed...

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  • Except in high risk patients a DTB analysis 2 years ago showed no benefit of higher dose statins. But, too often such a target [ eg HbA1C of 7.0 which actually causes more harm] is part of QOF and only there so that GPs cannot achieve these impossible targets rather than for clinical needs.

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