Combined statin and fenofibrate therapy and cardiorenal outcomes in patients with CKD, dyslipidemia, and ischemic heart disease
Yen-Chih Chang, Ming-Hsien Tsai, Yu-Wei Fang, Meng-Ting Chen, Ya-Hui Tseng, Cheng-Chun WeiAbstract
Background
Adults with non-dialysis-dependent chronic kidney disease (CKD), ischemic heart disease (IHD), and hypertriglyceridemia are at high cardiorenal risk; whether starting fenofibrate together with statin therapy is effective and safe in this population is uncertain.
Methods
In a multicenter retrospective cohort study emulating a target trial in the TriNetX Global Collaborative Network (2018–2024), 112 003 (28.5%) of 392 969 statin initiators with CKD and hypertriglyceridemia had IHD. Those without dialysis dependence were assigned to statin-fenofibrate combination therapy or statin monotherapy according to fenofibrate initiation within 3 months of the first statin prescription. The main outcomes were expanded major adverse cardiovascular events (MACE: acute myocardial infarction, stroke, heart failure, cardiac arrest, or all-cause death) and end-stage kidney disease (ESKD) necessitating dialysis. Propensity score matching yielded 3 191 pairs. Cox models estimated hazard ratios (HRs).
Results
Median follow-up was 881 days with combination therapy and 925 days with statin monotherapy. Combination therapy was associated with lower risks of MACE (1 472 [46.1%] vs. 1 576 [49.4%] events; HR, 0.93; 95% CI, 0.86–0.99) and ESKD necessitating dialysis (264 [8.3%] vs. 335 [10.5%]; HR, 0.79; 95% CI, 0.67–0.92). Risks of all-cause mortality (377 vs. 375), acute myocardial infarction (537 vs. 570), heart failure (1,059 vs. 1 134), stroke (310 vs. 312), acute kidney injury (825 vs. 840), and coded safety events were not significantly different between groups.
Conclusions
Among selected adults with non-dialysis-dependent CKD, hypertriglyceridemia, and IHD, statin-–fenofibrate combination therapy was associated with lower risks of MACE and of ESKD necessitating dialysis, without a significant increase in coded safety events.