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Intensive Statin Tx Cuts CVEs in Kidney Disease Patients
  By Ed Susman, Contributing Writer, MedPage Today
Published: March 18, 2010
Action Points
* Explain to interested patients that this study by the manfacturer of atorvastatin (Lipitor) suggests that heart disease patients with kidney disease and who have metabolic syndrome might benefit by increasing statin dosing.
* Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.
ATLANTA -- Intensive statin therapy was associated with a marked decrease in cardiovascular events and a modest improvement in renal function among heart patients with metabolic syndrome complicated by chronic kidney disease, industry researchers reported here.
The reduction in major cardiovascular events was 35% (P=0.0026) when patients were treated 80 mg of atorvastatin (Lipitor) versus 10 mg, according to Daniel J. Wilson, MD, senior medical director at the drug's manufacturer, Pfizer.
Pfizer sponsored the Treating to New Targets (TNT) study, which recruited 10,001 patients to determine whether higher doses of atorvastatin would improve outcomes versus a lower dose.
In the substudy described here at the American College of Cardiology meeting, Wilson and colleagues identified 1,859 high-risk coronary disease patients who also had metabolic syndrome and chronic kidney disease -- defined as those with an estimated glomerular filtration rate <60 ml/minute.
Over more than five years of follow-up, major cardiovascular events occurred in about 9% of the high-dose patients compared with more than 14% of patients taking the lower dose.
Wilson noted in his poster presentation that when the researchers compared patients who had no chronic kidney disease and no metabolic syndrome, there was no treatment effect for the dose of the statin (P=0.3855).
Wilson noted that the 10 mg atorvastatin dose resulted in a 1.5 ml/minute increase in glomerular filtration rate (P<0.02) from baseline, compared to a 3 ml/minute increase at 80 mg. The change at the higher dose was statistically significant compared with the lower dose (P<0.01) and baseline (P<0.001).
He said that as people age, the glomerular filtration rate usually declines, but in these patients with chronic kidney disease, the rate actually increased over the five years of the trial.
Roger Blumenthal, MD, professor of medicine at Johns Hopkins, said the findings regarding cardiovascular events are in line with other recent recent research.
"Recent studies have shown that adding non-statin agents to statin therapy may not be as effective as more aggressive treatment with a higher dose statin -- as was done in the TNT trial," he said.
But the glomerular filtration results may have been more interesting.
"As a subanalysis of the study," Blumenthal said, "this finding of an improvement in kidney function is intriguing and further exploration may be warranted."
Wilson is an employee of Pfizer, which sponsored the research.
Blumenthal had no relevant financial disclosures.
Primary source: American College of Cardiology
Source reference:
Deedwania P, et al "Cardiovascular event rates in stable coronary patients with chronic kidney disease, increased by the presence of obesity, are reduced by intensive lipid lowering with atorvastatin" ACC 2010, Abstract 1131-110.
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