Atorvastatin reduced risk for major CV events in patients with CAD, CKD, diabetes

Intensive lipid-lowering with high-dose atorvastatin significantly reduced the risk for major cardiovascular events in patients with coronary artery disease, type 2 diabetes and chronic kidney disease, according to recent results.

Researchers from Glasgow Royal Infirmary, Scotland randomly assigned 10,001 patients with CAD to double-blind therapy with either atorvastatin 80 mg or 10 mg per day, following eight weeks of open-label therapy.

During 4.8 years of follow-up, the researchers reported that 95 (17.4%) of 546 patients with diabetes and CKD experienced a major cardiovascular event, and 119 (13.4%) of 885 patients with diabetes and normal estimated glomerular filtration rates experienced an event (HR=1.32; P<.05).

Patients with diabetes and CKD assigned to atorvastatin 80 mg experienced a 35% reduction in RR for major cardiovascular events (HR=0.65; P=.04). Patients with diabetes and normal eGFRs experienced a 10% reduction in RR with the high dose (HR=0.90; P=.56). Both doses were well tolerated.

These results are in contrast with previous data for patients with diabetes and end-stage renal disease, according to the researchers. – by Katie Kalvaitis

Mayo Clin Proc. 2008;83:870-879.

The researchers of this study looked at data from the Treating to New Targets (TNT) trial of patients with stable CAD. They found that after five years of follow-up, atorvastatin 80 mg, as compared with 10 mg, decreased major cardiovascular events. The number needed to treat was 14 to prevent one major cardiovascular event. Of note, in a prior trial of patients assigned to dialysis, atorvastatin did not decrease events. Perhaps the length of follow-up time is key. Nevertheless, aggressive lipid-lowering in patients with moderate CKD does save lives.

– Roger S. Blumenthal, MD

Director, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease