{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:09:23Z","timestamp":1786975763412,"version":"build-2736575974"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n There are limited data for the utility of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) and death in adults with chronic kidney disease (CKD).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association of statin use with all-cause mortality and major adverse cardiovascular events (MACE) among US veterans older than 65 years with CKD stages 3 to 4.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study used a target trial emulation design for statin initiation among veterans with moderate CKD (stages 3 or 4) using nested trials with a propensity weighting approach. Linked Veterans Affairs (VA) Healthcare System, Medicare, and Medicaid data were used. This study considered veterans newly diagnosed with moderate CKD between 2005 and 2015 in the VA, with follow-up through December 31, 2017. Veterans were older than 65 years, within 5 years of CKD diagnosis, had no prior ASCVD or statin use, and had at least 1 clinical visit in the year prior to trial baseline. Eligibility criteria were assessed for each nested trial, and Cox proportional hazards models with bootstrapping were run. Analysis was conducted from July 2021 to October 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Statin initiation vs none.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcome was all-cause mortality; secondary outcome was time to first MACE (myocardial infarction, transient ischemic attack, stroke, revascularization, or mortality).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Included in the analysis were 14\u202f828 veterans. Mean (SD) age at CKD diagnosis was 76.9 (8.2) years, 14\u202f616 (99%) were men, 10\u202f539 (72%) White, and 2568 (17%) Black. After expanding to person-trials and assessing eligibility at each baseline, there were 151\u202f243 person-trials (14\u202f685 individuals) of nonstatin initiators and 2924 person-trials (2924 individuals) of statin initiators included. Propensity score adjustment via overlap weighting with nonparametric bootstrapping resulted in covariate balance, with mean (SD) follow-up of 3.6 (2.7) years. The hazard ratio for all-cause mortality was 0.91 (95% CI, 0.85-0.97) comparing statin initiators to noninitiators. The hazard ratio for MACE was 0.96 (95% CI, 0.91-1.02). Results remained consistent in prespecified subgroup analyses.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this target trial emulation of statin initiation in US veterans older than 65 years with CKD stages 3 to 4 and no prior ASCVD, statin initiation was significantly associated with a lower risk of all-cause mortality but not MACE. Results should be confirmed in a randomized clinical trial.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.46373","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T11:01:53Z","timestamp":1701860513000},"page":"e2346373","source":"Crossref","is-referenced-by-count":24,"title":["Statins, Mortality, and Major Adverse Cardiovascular Events Among US Veterans With Chronic Kidney Disease"],"prefix":"10.1001","volume":"6","author":[{"given":"Odeya","family":"Barayev","sequence":"first","affiliation":[{"name":"Ben Gurion University of the Negev, Be\u2019er Sheva, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chelsea E.","family":"Hawley","sequence":"additional","affiliation":[{"name":"New England Geriatric Research Education and Clinical Center, Bedford and Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Wellman","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Gerlovin","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Hsu","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System, Department of Pharmacy, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Paik","sequence":"additional","affiliation":[{"name":"New England Geriatric Research Education and Clinical Center, Bedford and Boston, Massachusetts"},{"name":"Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"},{"name":"Division of Renal Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernest I.","family":"Mandel","sequence":"additional","affiliation":[{"name":"Division of Renal Medicine, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine K.","family":"Liu","sequence":"additional","affiliation":[{"name":"Section of Geriatrics, Department of Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Geriatric Research Education and Clinical Center, Palo Alto VA Medical Center, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Djouss\u00e9","sequence":"additional","affiliation":[{"name":"Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston"},{"name":"Division of Aging, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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