Association of serum phosphate levels and statin use with cardiovascular events in Japanese patients on chronic haemodialysis: a post-hoc analysis of the LANDMARK trial.

Background: Statins have little beneficial effects on cardiovascular events (CVEs) in patients undergoing haemodialysis (HD) despite clinically relevant reductions in serum cholesterol levels. However, how time-dependent serum phosphate levels modify time-dependent statin use status in CVEs remains unclear. This study aimed to investigate whether statin use and time-dependent serum phosphate levels are associated with CVEs, cardiovascular death, atherosclerotic events and all-cause mortality. Methods: In this post-hoc analysis of the LANDMARK trial, we classified the Japanese patients according to statin use and serum phosphate levels and tested whether longitudinal phosphate exposure modulated the occurrence of outcomes. Results: Among 2135 patients on HD, 397 (18.6%) were prescribed statins at baseline, and 176 (8.2%) were prescribed statins during a median follow-up period of 3.2 years. Time-dependent statin administration was associated with a lower risk of all-cause death. However, there was no association between statin administration and serum phosphorus levels. Despite observing a trend towards a decreased risk of cardiovascular and atherosclerotic events for time-dependent phosphate levels <5 mg/dL during the statin prescription period, this trend was not significant. No clinical benefits of statin use on cardiovascular mortality or all-cause mortality were observed. Conclusion: Time-dependent statin use was associated with a lower risk of all-cause death. However, statin and serum phosphate levels were not significantly associated with lower risk of CVEs or mortality.