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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Relation Between Change in Renal Function and Cardiovascular Outcomes in Atorvastatin-Treated Patients (from the
James Shepherd1, Andrei Breazna2, Prakash C Deedwania3
1Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.
Insights
Improving kidney function with statins significantly lowers cardiovascular event risk in coronary heart disease patients. Maintaining stable or improving estimated glomerular filtration rate (eGFR) is linked to better outcomes.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- Statins are known for cardioprotective effects and may offer nephroprotective benefits.
- Cardiovascular disease (CVD) patients often have comorbid renal function changes.
- The Treating to New Targets (TNT) study investigated atorvastatin's effects in coronary heart disease (CHD).
Purpose of the Study:
- To assess the relationship between changes in estimated glomerular filtration rate (eGFR) and major cardiovascular events (MCVEs) in patients treated with atorvastatin.
- To determine if maintaining or improving renal function influences cardiovascular outcomes in CHD patients.
Main Methods:
- Analysis of 9,500 patients from the TNT study randomized to atorvastatin 10 or 80 mg/day.
- Patients were stratified based on intrastudy change in eGFR: improving (>+2 ml/min/1.73 m(2)), stable (-2 to +2 ml/min/1.73 m(2)), and worsening (< -2 ml/min/1.73 m(2)).
- The risk of MCVEs (CHD death, myocardial infarction, cardiac arrest, stroke) was compared across renal function strata.
Main Results:
- Patients with stable renal function had a 28% lower MCVE rate compared to those with worsening renal function (HR 0.72).
- Patients with improving renal function showed a 64% lower MCVE rate versus those with worsening renal function (HR 0.36).
- Each 1 ml/min/1.73 m(2) increase in eGFR was associated with a 2.7% absolute reduction in MCVE rate, with greater benefit seen at 80 mg atorvastatin.
Conclusions:
- Stabilization or improvement in eGFR during atorvastatin treatment in CHD patients is associated with a reduced risk of major cardiovascular events.
- Progressive renal impairment in statin-treated CHD patients indicates a high risk for future cardiovascular events.
- Atorvastatin demonstrates potential benefits for both cardiovascular and renal health in patients with coronary heart disease.
Abstract:
Statins may have nephroprotective as well as cardioprotective effects in patients with cardiovascular disease. In the Treating to New Targets (TNT) study (NCT00327691), patients with coronary heart disease (CHD) were randomized to atorvastatin 10 or 80 mg/day and followed for 4.9 years. The relation between intrastudy change in estimated glomerular filtration rate (eGFR) from baseline and the risk of major cardiovascular events (MCVEs, defined as CHD death, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke) was assessed among 9,500 patients stratified by renal function: improving (change in eGFR more than +2 ml/min/1.73 m(2)), stable (-2 to +2 ml/min/1.73 m(2)), and worsening (less than -2 ml/min/1.73 m(2)). Compared with patients with worsening renal function (1,479 patients, 15.6%), the rate of MCVEs was 28% lower in patients with stable renal function (2,241 patients, 23.6%) (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.60 to 0.87; p = 0.0005) and 64% lower in patients with improving renal function (5,780 patients, 60.8%; HR 0.36; 95% CI 0.30 to 0.43; p <0.0001). For each 1 ml/min/1.73 m(2) increase in eGFR, the absolute reduction in the rate of MCVEs was 2.7% (HR 0.973; 95% CI 0.967 to 0.980; p <0.0001). An absolute MCVE rate reduction per 1 ml/min/1.73 m(2) increase in eGFR of 2.0% was reported with atorvastatin 10 mg and 3.3% with atorvastatin 80 mg. In conclusion, intrastudy stabilization or increase in eGFR in atorvastatin-treated patients with CHD from the TNT study was associated with a reduced rate of MCVEs. Statin-treated CHD patients with progressive renal impairment are at high risk for future cardiovascular events.
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