Abstract 2173: Effect of High-dose Atorvastatin on Changes in Renal Function: A Secondary Analysis of the Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) Trial
Background: In SPARCL treatment with atorvastatin 80 mg/d reduced the risk of stroke, cardiovascular events and revascularizations in patients with recent stroke or TIA and no known coronary heart disease. This post hoc analysis evaluated changes in renal function during the study.
Methods: We randomly assigned 4731 patients with stroke or TIA within 1–6 months and with LDL levels of 100–190 mg/dL to atorvastatin 80 mg daily or placebo. Patients with severe renal dysfunction or nephrotic syndrome were excluded. Serum creatinine levels were measured at baseline and annually (mean 4.9 years of follow-up). Glomerular filtration rate was estimated (eGFR) by the Modification of Diet in Renal Disease (MDRD) method. For this analysis the study population was divided into 3 groups based upon baseline glycemic status: Group 1 (n=3156), no metabolic syndrome or type 2 diabetes; Group 2 (n=781), metabolic syndrome; and group 3 (n=794), type 2 diabetes. Treatment effects were compared by 2-way ANOVA across all 3 groups between baseline and last study visits.
Results: At baseline mean creatinine was 1.11, 1.13, and 1.11 mg/dL in Groups 1, 2, and 3, respectively, and mean eGFR was 68.01, 66.81, and 68.0 mL/min/1.73 m2, respectively. Over the course of the study, eGFR increased in atorvastatin-treated subjects in Groups 1 and 2 (1.269 and 1.973 mL/min/1.73 m2, respectively), whereas placebo patients had no change (0.005 and 0.016 mL/min/1.73 m2, respectively; p=0.001, p=0.016). Over the course of the study, eGFR decreased in Group 3. However, atorvastatin-treated subjects had a −0.735 mL/min/1.73 m2 change in eGFR compared to −4.016 mL/min/1.73 m2 in placebo subjects with type 2 diabetes (p<0.001).
Conclusion: Treatment with atorvastatin 80 mg/d was associated with slight but significant improvement in eGFR in SPARCL subjects without or with metabolic syndrome and a reduction in the decline in eGFR in those with type 2 diabetes at baseline. This analysis suggests treatment with atorvastatin 80 mg/d may provide renoprotection in addition to benefit in multiple vascular beds.