Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study.

Description

In these post-hoc analyses of the Treating to New Targets (TNT) trial, Shepherd et al. investigated the effect of intensive cholesterol-lowering therapy in patients with coronary heart disease and chronic kidney disease (CKD) identified on the basis of an estimated glomerular filtration rate. Of the 9,656 patients randomized to either atorvastatin 80 mg/day or atorvastatin 10 mg/day, 3,107 had prevalent CKD. Median follow-up was 5 years. Compared to patients with CKD who remained free of cardiovascular disease (CVD), those with CKD who experienced a major cardiovascular event had a greater CVD risk [HR: 1.35, (95% CI, 1.18-1.54; p<0.0001)]. In patients with CKD, atorvastatin 80 mg reduced the relative risk of major cardiovascular events by 32%. For patients without CKD, relative risk was reduced by 15%. Given the fact that both doses were well tolerated, the authors concluded that patients with CKD who have a considerably greater CVD risk could benefit from aggressive lipid-lowering therapy.