Evidence map›Statins × cardiovascular events›PMID 18299289›Full record

SynthesisBMJ (Clinical research ed.)2008

Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials.

Giovanni F M Strippoli, Sankar D Navaneethan, David W Johnson, Vlado Perkovic, Fabio Pellegrini, Antonio Nicolucci, Jonathan C Craig

Erratum issuedOpen access · bronzeAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2008. The graph read 4 numbers from its abstract, feeding 3 cells of the map: it supports the treatment in 2, finds no clear difference in 1. An erratum has been issued. Cited by 107 papers, 9 of them syntheses that pooled it.

4numbers the graph read from it
3cells of the map it votes in
107citing papers in PubMed, 9 pooled it
29.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Ratios

← favours the treatmentfavours the comparator →
1 · no effect
All cause mortalitystatins vs placebono clear difference · ascvd, ckdfeeds one cell of the map
RR 0.920.82 to 1.03
Fatal cardiovascular events (43 studies, 23 266 patients; relative risk 0.81, 0.73 to 0.90) and non-fatal cardiovascular events (8 studies, 22 863 patients; 0.78, 0.73 to 0.84) were reduced with statins, but statins had no significant effect on all cause mortality (44 studies, 23 665 patients; 0.92, 0.82 to 1.03).
FeedsStatins×all-cause mortality
Non-fatal cardiovascular eventsstatins vs placebofavours the treatment · ascvd, ckdfeeds one cell of the map
RR 0.780.73 to 0.84
Fatal cardiovascular events (43 studies, 23 266 patients; relative risk 0.81, 0.73 to 0.90) and non-fatal cardiovascular events (8 studies, 22 863 patients; 0.78, 0.73 to 0.84) were reduced with statins, but statins had no significant effect on all cause mortality (44 studies, 23 665 patients; 0.92, 0.82 to 1.03).
FeedsStatins×cardiovascular events
Fatal cardiovascular eventsstatins vs placebofavours the treatment · ascvd, ckdfeeds one cell of the map
RR 0.810.73 to 0.90
Fatal cardiovascular events (43 studies, 23 266 patients; relative risk 0.81, 0.73 to 0.90) and non-fatal cardiovascular events (8 studies, 22 863 patients; 0.78, 0.73 to 0.84) were reduced with statins, but statins had no significant effect on all cause mortality (44 studies, 23 665 patients; 0.92, 0.82 to 1.03).
FeedsStatins×cardiovascular events

Differences

← favours the treatmentfavours the comparator →
-47.30 · no effect
Total cholesterolstatins vs placebofavours the treatment · ascvd, ckdfeeds one cell of the map
Δ -42.3-47.3 to -37.3
Compared with placebo, statins significantly reduced total cholesterol (42 studies, 6390 patients; weighted mean difference -42.28 mg/dl (1.10 mmol/l), 95% confidence interval -47.25 to -37.32), low density lipoprotein cholesterol (39 studies, 6216 patients; -43.12 mg/dl (1.12 mmol/l), -47.85 to -38.40), and proteinuria (g/24 hours) (6 trials, 311 patients; -0.73 g/24 hour, -0.95 to -0.52) but did not improve glomerular filtration rate (11 studies, 548 patients; 1.48 ml/min (0.02 ml/s), -2.32 to 5.28).
FeedsStatins×lipids

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×cardiovascular events

SupportsOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascul…PMID 27040132 · 12,705 enrolled · 2007
HR 0.760.64 to 0.91
NCT023442907,769 enrolled · 2015
HR 0.640.48 to 0.84
Extended-release niacin therapy and risk of ischemic stroke in patient…PMID 23881958 · 3,414 enrolled · 2005
HR 1.781.00 to 3.17
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
A randomized trial of rosuvastatin in the prevention of venous thrombo…PMID 19329822 · 2009
HR 0.610.35 to 1.09
Effect of fluvastatin on cardiac outcomes in renal transplant recipien…PMID 12814712 · 2003
RR 0.830.64 to 1.06
The effect of rosuvastatin on incident pneumonia: results from the JUP…PMID 22431901 · 2012
HR 0.810.67 to 0.97
Simvastatin for secondary prevention of all-cause mortality and major …PMID 17336698 · 2007
HR 0.620.49 to 0.77
Long-term benefits of atorvastatin on the incidence of cardiovascular …PMID 40139683 · 2025
HR 0.880.80 to 0.98
Fluvastatin and perioperative events in patients undergoing vascular s…PMID 19726772 · 2009
HR 0.470.24 to 0.94
Reduction in cardiovascular events with atorvastatin in 2,532 patients…PMID 15855581 · 2005
HR 0.770.61 to 0.98
Intensive lipid lowering with simvastatin and ezetimibe in aortic sten…PMID 18765433 · 2008
HR 0.960.83 to 1.12

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×lipids

SupportsOpen on the map →What to test next →

38 readable studies in this cell: 28 favour the treatment, 4 find no difference, 6 favour the comparator.

Belief with this paper
0.50contested · 21 families support, 7 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
0 · no effect
NCT002899002,340 enrolled · 2006
Δ -13.2-16.8 to -9.60
Effect of evolocumab or ezetimibe added to moderate- or high-intensity…PMID 24825642 · 2,067 enrolled · 2013
reduced -66.0-73.0 to -58.0
NCT02546323543 enrolled · 2015
Δ -35.5-40.2 to -30.7
NCT01678820299 enrolled · 2012
Δ 0.50-4.80 to 5.80
NCT01218204287 enrolled · 2010
Δ 5.47-15.7 to 26.7
Lipid-Lowering Effect and Safety of Ezetimibe and Atorvastatin 5 mg in…PMID 40357888 · 252 enrolled · 2022
Δ -47.6
NCT0093525931 enrolled · 2009
Δ -51.7
Effect of Patient Financial Incentives on Statin Adherence and Lipid C…PMID 33034639 · 2020
reductions -33.6-38.8 to -28.4
Icosabutate, a Structurally Engineered Fatty Acid, Improves the Cardio…PMID 27160246 · 2016
Δ -7.40
Evidence for statin pleiotropy in humans: differential effects of stat…PMID 19075102 · 2009
RR 38.0
Efficacy and safety of fluvastatin in patients with non-insulin-depend…PMID 8198023 · 1994
decrease -24.3
Rosuvastatin in older patients with systolic heart failure.PMID 17984166 · 2007
Δ 37.1

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×all-cause mortality

InconclusiveOpen on the map →What to test next →

14 readable studies in this cell: 3 favour the treatment, 9 find no difference, 2 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT023442907,769 enrolled · 2015
HR 0.880.70 to 1.12
Effect of rosuvastatin in patients with chronic heart failure (the GIS…PMID 18757089 · 6,975 enrolled · 2002
HR 1.010.91 to 1.11
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19
Major outcomes in moderately hypercholesterolemic, hypertensive patien…PMID 12479764 · 2002
RR 0.990.89 to 1.11
[Clinical study of the month. The ALLHAT-LLT trial].PMID 12647600 · 2003
RR 0.990.89 to 1.11
Rosuvastatin and cardiovascular events in patients undergoing hemodial…PMID 19332456 · 2009
HR 0.960.86 to 1.07
Rosuvastatin for primary prevention in older persons with elevated C-r…PMID 20404379 · 2010
HR 0.800.62 to 1.04
The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follo…PMID 21873710 · 2011
HR 0.860.76 to 0.98
Rosuvastatin to prevent vascular events in men and women with elevated…PMID 18997196 · 2008
HR 0.800.67 to 0.97
Long-term follow-up of moderately hypercholesterolemic hypertensive pa…PMID 23889716 · 2013
HR 0.960.89 to 1.03
Pravastatin and cardiovascular outcomes stratified by baseline eGFR in…PMID 23816477 · 2013
HR 1.010.91 to 1.13
Association Between Use of Statins and Mortality in Patients With Hear…PMID 26243795 · 2015
HR 0.800.72 to 0.89

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

107 citing papers in PubMed, 9 syntheses or guidelines pooled it, 399 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Renal failure (chronic).BMJ clinical evidence · 2011
    Pooled it
  8. Pooled it
  9. Pooled it
  10. Trial
  11. Trial
  12. Trial
  13. Rosuvastatin preserves renal function and lowers cystatin C in HIV-infected subjects on antiretroviral therapy: the SATURN-HIV trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014
    Trial
  14. Trial
  15. Trial
  16. Trial
  17. Cost-effectiveness analysis of a randomized trial comparing care models for chronic kidney disease.Clinical journal of the American Society of Nephrology : CJASN · 2011
    Trial
  18. Trial
  19. Trial
  20. Trial

47 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

7 authors at 6 institutions in 3 countries.

Giovanni F M StrippoliNHMRC Centre for Clinical Research Excellence in Renal Medicine, School of Public Health, University of Sydney, Australia.
Sankar D Navaneethan
David W Johnson
Vlado Perkovic
Fabio Pellegrini
Antonio Nicolucci
Jonathan C Craig
Mario Negri Sud Foundation · ITNational Health and Medical Research Council · AUThe George Institute for Global Health · AUUniversity of Queensland · AUUniversity of Rochester · USUniversity of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

objectiveTo analyse the benefits and harms of statins in patients with chronic kidney disease (pre-dialysis, dialysis, and transplant populations).

designMeta-analysis. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, Embase, and Renal Health Library (July 2006). STUDY SELECTION: Randomised and quasi-randomised controlled trials of statins compared with placebo or other statins in chronic kidney disease. DATA EXTRACTION AND ANALYSIS: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Treatment effects were summarised as relative risks or weighted mean differences with 95% confidence intervals by using a random effects model.

resultsFifty trials (30 144 patients) were included. Compared with placebo, statins significantly reduced total cholesterol (42 studies, 6390 patients; weighted mean difference -42.28 mg/dl (1.10 mmol/l), 95% confidence interval -47.25 to -37.32), low density lipoprotein cholesterol (39 studies, 6216 patients; -43.12 mg/dl (1.12 mmol/l), -47.85 to -38.40), and proteinuria (g/24 hours) (6 trials, 311 patients; -0.73 g/24 hour, -0.95 to -0.52) but did not improve glomerular filtration rate (11 studies, 548 patients; 1.48 ml/min (0.02 ml/s), -2.32 to 5.28). Fatal cardiovascular events (43 studies, 23 266 patients; relative risk 0.81, 0.73 to 0.90) and non-fatal cardiovascular events (8 studies, 22 863 patients; 0.78, 0.73 to 0.84) were reduced with statins, but statins had no significant effect on all cause mortality (44 studies, 23 665 patients; 0.92, 0.82 to 1.03). Meta-regression analysis showed that treatment effects did not vary significantly with stage of chronic kidney disease. The side effect profile of statins was similar to that of placebo. Most of the available studies were small and of suboptimal quality; mortality data were provided by a few large trials only.

conclusionStatins significantly reduce lipid concentrations and cardiovascular end points in patients with chronic kidney disease, irrespective of stage of disease, but no benefit on all cause mortality or the role of statins in primary prevention has been established. Reno-protective effects of statins are uncertain because of relatively sparse data and possible outcomes reporting bias.

Indexed as

Cardiovascular DiseasesCreatinineGraft RejectionHumansHydroxymethylglutaryl-CoA Reductase InhibitorsKidney Failure, ChronicKidney TransplantationLipidsProteinuriaRandomized Controlled Trials as TopicTreatment OutcomeTriglyceridesCreatinineHydroxymethylglutaryl-CoA Reductase InhibitorsLipidsTriglycerides

Identifiers

PMID18299289
PMCPMC2270960
OpenAlexW1993266652

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.