Association between statin use and major adverse cardiovascular events in patients with chronic kidney disease and cardiomyopathy: A retrospective case-control study

This study aimed to investigate the association between statin use and the risk of major adverse cardiovascular events (MACE) among patients with chronic kidney disease (CKD) complicated by cardiomyopathy, and to further evaluate the effects of different statin doses and types on cardiovascular outcomes. This single-center retrospective case-control study included 765 patients with CKD and cardiomyopathy hospitalized between January 2016 and February 2025. Patients were categorized according to statin exposure and atorvastatin-equivalent doses. Multivariable logistic regression and subgroup analyses were performed to evaluate the association between statin use and MACE, adjusting for demographic, clinical, and laboratory confounders. A total of 765 eligible patients with CKD and cardiomyopathy were included, comprising 255 cases and 510 controls. Overall, the prevalence of statin use was 59.6%, which was significantly lower in the case group than in controls (48.2% vs 65.3%, P <.001). Univariate analysis showed that statin use was significantly associated with a reduced risk of MACE (unadjusted odds ratio = 0.52, 95% CI: 0.38-0.70, P <.001). Dose-response analysis revealed that the incidence of MACE decreased progressively across nonuser, low-to-moderate, and high-dose groups (41.1% vs 28.7% vs 20.2%, P for trend = .002). In multivariable logistic regression adjusting for age, sex, body mass index, diabetes and hypertension control, estimated glomerular filtration rate (eGFR), and β-blocker use, regular statin therapy remained independently associated with lower MACE risk, with the strongest benefit observed in the high-dose group (adjusted odds ratio = 0.47, 95% CI: 0.31-0.72, P = .001). Subgroup analyses demonstrated consistent protective effects of statin therapy across CKD stages and cardiomyopathy etiologies (ischemic vs nonnon; P for interaction >.05). In patients with CKD and cardiomyopathy, regular statin therapy significantly reduces the incidence of MACE in a dose-dependent manner. The cardioprotective effect remains consistent across different CKD stages and cardiomyopathy etiologies. Statin treatment is generally well tolerated, with only mild, reversible elevations in liver enzymes or muscle enzymes and no serious adverse reactions.