Statin Use and the Presence of Microalbuminuria. Results from the ERICABEL Trial: A Non-Interventional Epidemiological Cohort Study

BACKGROUND: Microalbuminuria (MAU) is considered as a predictor or marker of cardiovascular and renal events. Statins are widely prescribed to reduce cardiovascular risk and to slow down progression of kidney disease. But statins may also generate tubular MAU. The current observational study evaluated the impact of statin use on the interpretation of MAU as a predictor or marker of cardiovascular or renal disease. METHODOLOGY/PRINCIPAL FINDINGS: We used cross-sectional data of ERICABEL, a cohort with 1,076 hypertensive patients. MAU was defined as albuminuria ≥20 mg/l. A propensity score was created to correct for "bias by indication" to receive a statin. As expected, subjects using statins vs. no statins had more cardiovascular risk factors, pointing to bias by indication. Statin users were more likely to have MAU (OR: 2.01, 95%CI: 1.34-3.01). The association between statin use and MAU remained significant after adjusting for the propensity to receive a statin based on cardiovascular risk factors (OR: 1.82, 95%CI: 1.14-2.91). Next to statin use, only diabetes (OR: 1.92, 95%CI: 1.00-3.66) and smoking (OR: 1.49, 95%CI: 0.99-2.26) were associated with MAU. CONCLUSIONS: Use of statins is independently associated with MAU, even after adjusting for bias by indication to receive a statin. In the hypothesis that this MAU is of tubular origin, statin use can result in incorrect labeling of subjects as having a predictor or marker of cardiovascular or renal risk. In addition, statin use affected the association of established cardiovascular risk factors with MAU, blurring the interpretation of multivariable analyses

Baseline characteristics (categorical variables).

<p>MS: metabolic syndrome, MAU: microalbuminuria, ACE-I/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker, CVevent: cardiovascular event.</p><p>p*:p values between all three groups; p§: p value between users vs. non statin users.</p

Association between statin use and microalbuminuria (MAU).

<p>$ Pscore = propensity score; The propensity score was fit using a restricted cubic spline.</p><p>ACE-I/ARB: angiotensin converting enzyme inhibitor/angiotensin receptor blocker, CV event: cardiovascular event, BMI: body mass index, BP: Blood pressure, CRP: C-reactive protein.</p

Baseline characteristics (continuous variables).

<p>BMI: body mass index, SBP: systolic blood pressure, DBP diastolic blood pressure, CRP: C-reactive protein. p*:p values between all three groups; p§: p value between users vs. non statin users.</p