Intensive Atorvastatin Therapy Reduces CV Events in Patients with Dyslipidemia and CHD with Chronic Kidney Disease
NEW ORLEANS, LA—The use of intensive atorvastatin therapy in patients with more advanced chronic kidney disease (CKD) provides statistically significant reductions in cardiovascular events (CVE), results of a retrospective analysis showed at a presentation at ACC.11, the American College of Cardiology's 60th Annual Scientific Session. These results suggest that degree of lipid lowering observed with statin therapy may be related to level of renal insufficiency in a patient.
Previous analyses have demonstrated that statins reduce CVE in coronary heart disease (CHD) subjects with mild renal impairment. To evaluate the effect of more intensive vs. less intensive statin therapy on CVE in patients with more advanced CKD (without end-stage renal disease), investigators performed a retrospective analysis of three long-term trials (TNT, IDEAL, and ALLIANCE) in subjects with CHD and dyslipidemia. Each study compared aggressive atorvastatin therapy with an active comparator: atorvastatin 80mg vs. atorvastatin 10mg in TNT; atorvastatin 80mg vs. simvastatin 20–40mg in IDEAL; and atorvastatin 40mg [mean dose] vs. usual care in ALLIANCE. The primary endpoint for this analysis was any CVE, defined as CHD death, nonfatal MI, coronary revascularization, hospitalization for angina or heart failure, cerebrovascular event, or peripheral vascular disease.
A total of 20,961 subjects were identified. On the basis of an MDRD eGFR <60mL/min/1.73m2, 28.7% (n=6,007) had CKD (eGFR 52.44 ± 6.71mL/min/1.73m2) at baseline. Of those with CKD, 71.1% (n=4,268) had mild CKD (eGFR 55.96 ± 2.82mL/min/1.73m2) vs. 28.9% (n=1,739) with more advanced CKD (eGFR 43.80 ± 5.58mL/min/1.73m2). Similar numbers of CKD subjects were then randomized into aggressive vs. less intensive but lowering therapies.
A total of 2,057 CVE occurred in the CKD population, with CVE rates consistently higher in those with more advanced CKD. Statistically significant reductions in CVE were seen with aggressive therapy with atorvastatin vs. comparator therapies in both those with mild (28.5% vs. 34.9%, HR=0.779 [0.700–0.867]; P<0.0001]) or more advanced CKD (37.3% vs. 44.04%, HR=0.795 [0.686–0.922]; P=0.0025). Treatment interaction by mild/advanced CKD was nonsignificant.
Daniel J. Wilson, MD from Pfizer Inc. and colleagues concluded that although additional studies are warranted, clinicians should give consideration to utilizing or recommending aggressive treatment for dyslipidemia in patients with CHD patients and CKD in an effort to reduce major CVEs associated with the progression of renal disease.