Abstract 848: Improvement in Estimated Glomerular Filtration Rate With Atorvastatin in Patients With Metabolic Syndrome: The Treating to New Targets Study
Background: Metabolic syndrome (MetS) is a known risk factor for the development and progression of chronic kidney disease (CKD). Aggressive management of dyslipidemia with statins is recommended to prevent progression of CKD in MetS, yet little data is available on how renal function changes in response to statin therapy in MetS. Dose dependent improvement in renal function with intensive lipid lowering with atorvastatin (ATV) 80 mg vs 10 mg has previously been demonstrated in the TNT study. This post-hoc analysis examines change in estimated glomerular filtration rate (eGFR) with ATV 80 mg and 10 mg in patients with and without MetS.
Methods: After 8 weeks open-label therapy with ATV 10 mg, 10,001 patients with CHD were randomized to double-blind therapy with either ATV 10 or 80 mg and followed for a median of 4.9 years for the occurrence of the primary endpoint (CHD death, nonfatal MI, and stroke). Change in eGFR (using the MDRD equation) from baseline to last visit prior to primary endpoint was assessed according to MetS status. MetS was deemed present in patients with 3 or more of BMI ≥28 kg/m2, triglycerides >150mg/dL, HDL-C <40 mg/dL (men), <50 mg/dL (women), BP ≥130/85 mmHg, or fasting glucose ≥100 mg/dL.
Results: Of the total cohort, 9500 patients with a follow-up eGFR prior to primary endpoint were included. Mean baseline eGFR was 64.4 mL/min/1.73 m2 in patients with MetS (n=5287) and 66.5 mL/min/1.73 m2 in patients without MetS (n=4213). Mean change from baseline eGFR was greater in patients receiving ATV 80 mg than ATV 10 mg, regardless of MetS status. The magnitude of increase in eGFR was numerically greater in patients without than in those with MetS, however, there was no treatment interaction by MetS status for change in eGFR.
Conclusions: In patients with stable CHD there was a dose dependent increase in mean eGFR associated with ATV therapy, irrespective of MetS status. High intensity statin therapy for dyslipidemia in MetS should be considered, to prevent progression of CKD.