Intensive lipid lowering with atorvastatin 80 mg/day reduced the risk of major cardiovascular events by 32% compared to 10 mg/day in patients with coronary heart disease and chronic kidney disease (HR 0.68; 95% CI 0.55-0.84; P=0.0003).
RCT (n=10,001)
Double-blind
randomized
Does intensive lipid lowering with atorvastatin 80 mg/day reduce major cardiovascular events in patients with coronary heart disease and chronic kidney disease compared to atorvastatin 10 mg/day?
Intensive lipid lowering with atorvastatin 80 mg/day significantly reduces major cardiovascular events in patients with coronary heart disease and chronic kidney disease compared to standard-dose atorvastatin 10 mg/day.
Hazard Ratio: 0.68 (95% CI 0.55–0.84)
valor p: p=0.0003
OBJECTIVES: This subanalysis of the TNT (Treating to New Targets) study investigates the effects of intensive lipid lowering with atorvastatin in patients with coronary heart disease (CHD) with and without pre-existing chronic kidney disease (CKD). BACKGROUND: Cardiovascular disease is a major cause of morbidity and mortality in patients with CKD. METHODS: A total of 10,001 patients with CHD were randomized to double-blind therapy with atorvastatin 80 mg/day or 10 mg/day. Patients with CKD were identified at baseline on the basis of an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) using the Modification of Diet in Renal Disease equation. The primary efficacy outcome was time to first major cardiovascular event. RESULTS: Of 9,656 patients with complete renal data, 3,107 had CKD at baseline and demonstrated greater cardiovascular comorbidity than those with normal eGFR (n = 6,549). After a median follow-up of 5.0 years, 351 patients with CKD (11.3%) experienced a major cardiovascular event, compared with 561 patients with normal eGFR (8.6%) (hazard ratio HR = 1.35; 95% confidence interval CI 1.18 to 1.54; p < 0.0001). Compared with atorvastatin 10 mg, atorvastatin 80 mg reduced the relative risk of major cardiovascular events by 32% in patients with CKD (HR = 0.68; 95% CI 0.55 to 0.84; p = 0.0003) and 15% in patients with normal eGFR (HR = 0.85; 95% CI 0.72 to 1.00; p = 0.049). Both doses of atorvastatin were well tolerated in patients with CKD. CONCLUSIONS: Aggressive lipid lowering with atorvastatin 80 mg was both safe and effective in reducing the excess of cardiovascular events in a high-risk population with CKD and CHD.
“People with chronic kidney disease are more likely to die from heart disease than to develop kidney failure. It is critical for us to find new ways to reduce cardiovascular burden in these patients. Intensive statin therapy seems to be at least part of the solution.”
Shepherd et al. (Tue,) conducted a rct in Coronary heart disease and chronic kidney disease (n=10,001). Atorvastatin vs. Atorvastatin 10 mg/day was evaluated on Time to first major cardiovascular event (HR 0.68, 95% CI 0.55-0.84, p=0.0003). Intensive lipid lowering with atorvastatin 80 mg/day reduced the risk of major cardiovascular events by 32% compared to 10 mg/day in patients with coronary heart disease and chronic kidney disease (HR 0.68; 95% CI 0.55-0.84; P=0.0003).