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High-Dose Atorvastatin Reduces Risk of Cardiovascular events in Patients With Chronic Kidney Disease: Presented at AHA

By Ed Susman

CHICAGO, IL -- November 17, 2006 -- Aggressive cholesterol-lowering using a high-dose of atorvastatin (Lipitor) significantly reduced cardiovascular events when compared with low doses among people who have kidney disease, researchers said here at the American Heart Association (AHA) 2006 Scientific Sessions.

In reviewing data from The Treating to New Targets trial, James Shepherd, MB, PhD, professor of medicine, University of Glasgow, Scotland, United Kingdom, said, "High-dose atorvastatin therapy is safe and provides additional benefit in reducing cardiovascular events in patients with coronary disease and chronic kidney disease."

Dr. Shepherd reported on November 15^th in an oral presentation on his post-hoc analysis of data derived from the 10,001 patients enrolled in the TNT trial.

In the new analysis patients were divided by estimated baseline level of glomerular filtration rate. A GFR less than 60 mL/min is considered by the National Kidney Foundation to represent chronic kidney disease.

Dr. Shepherd said that a major cardiovascular event occurred in 11.9% of patients with GFR under 60 mL/min compared with 8.9% of those with GFR readings higher than 60 mL/min. He said the difference which reached significance at the P < .0001 level indicates that chronic kidney disease is a heart disease risk.

Using the Modification of Diet in Renal Disease (MDRD) equation for estimated GFR, 1,301 patients with GFR under 60 were randomized to receive 10 mg of atorvastatin in the TNT Trial and 1,355 were assigned to receive 80 mg of atorvastatin.

After an average follow-up of 4.9 years, 14.9% of the patients on low-dose atorvastatin experienced a major cardiovascular event, compared with 9.2% of patients on high-dose of atorvastatin. This represents a 40% relative-risk reduction of having a major event if the patient was taking the high dose.

However, Dr. Shepherd also found that patients with GFR higher than 60 mL/min also benefited from having high-dose atorvastatin. He said 2,813 patients with GFR higher than 60 mL/min were assigned to receive atorvastatin 10 mg while 2,764 similar patients were assigned to get atorvastatin 80 mg.

In that group with better kidney function at baseline, 9.6% of the patients on the low-dose atorvastatin experienced a major cardiovascular event compared with 8.1% of those patients taking the high dose, representing a reduction of 16%.


[Presentation title: Intensive Lipid Lowering With Atorvastatin is Associated With Significant Cardiovascular Benefits in Patients With and Without Chronic Kidney Disease: The Treating to New Targets (TNT) Study. Abstract 3731]

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