Abstract 3731: 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
Chronic kidney disease (CKD) is linked to increases in cardiovascular (CV) events, death and hospitalization. However, few studies have examined the effect of statins in reducing CV events in the CKD population. The current subanalysis of the TNT study investigates the effect of intensive lipid lowering with atorvastatin (ATV) 80 mg on the incidence of major CV events compared with ATV 10 mg in patients with and without CKD. A total of 10,001 patients with coronary disease and LDL-C levels of <130 mg/dL were randomized to double-blind therapy with either ATV 10 mg or 80 mg following 8 weeks open-label therapy with ATV 10 mg. Two serum creatinine-based estimates of glomerular filtration rate (eGFR) were used to determine renal function: the Modification of Diet in Renal Disease (MDRD) and the Cockcroft-Gault (CG) equation. Patients with CKD were defined according to National Kidney Foundation guidelines as having a baseline eGFR <60 mL/min/1.73 m2. Baseline renal data were available for 8233 patients (4114 on ATV 10 mg and 4119 on ATV 80 mg). Patients with baseline eGFR <60 using the MDRD (n=2656) had greater CV comorbidity at baseline than those with eGFR <60 (n=5577). After a median follow-up of 4.9 years, 316 patients (11.9%) with eGFR <60 experienced a major CV event, compared with 496 patients (8.9%) with eGFR ≥60 (HR 0.73, 95% CI 0.64 – 0.84, P<0.0001). Compared with ATV 10 mg, ATV 80 mg reduced the relative risk of major CV events by 40% in patients with eGFR <60 and by 16% in patients with eGFR ≥60. Furthermore the absolute risk reduction in patients with eGFR <60 was substantial, yielding a NNT of 18 to prevent one major CV event over 4.9 years. Similar event reductions were observed with the CG equation (Table⇓). Both treatments were well tolerated. In summary, reductions in CV events with ATV 80 mg occurred in both eGFR groups, but were greater in patients with CKD. Thus, high-dose ATV therapy is safe and provides additional benefit in reducing CV events in patients with coronary disease and CKD.