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Patients With CHD, Obesity, and Renal Disease Benefit From High-Dose Atorvastatin: Presented at ACC By Bruce Sylvester ATLANTA -- March 17, 2010 -- High-intensity atorvastatin (ATV) therapy is associated with significant benefits for coronary heart disease (CHD) patients with concomitant obesity and chronic kidney disease (CKD) according to researchers here at the 59th Annual Scientific Session of the American College of Cardiology (ACC). “In the original TNT [Treating to New Targets] trial, we found that concomitant obesity and CKD appeared in 1 in 10 of the CHD patients and were associated with a significant increase in cardiovascular risk compared to patients without either CKD or obesity,” said Prakash Deedwania, MD, University of California, San Francisco School of Medicine, Fresno, California, on March 15. “In this subanalysis of TNT, we found that intensive LDL [low-density lipoprotein] cholesterol reduction with atorvastatin 80 mg associated with a significant reduction in cardiovascular events in patients with obesity and CKD.” In TNT, after 8 weeks of open-label therapy with ATV 10 mg, investigators randomised 10,001 CHD patients to double-blind therapy with ATV 10 or 80 mg/day, with follow-up of 4.9 years. They defined obesity as body mass index >=30 kg/m2 and CKD as a glomerular filtration rate of <60 mL/min/1.73 m2 using the modified 4 component modification of diet in renal disease equation. In the predefined TNT cohort with complete renal data (n = 9,500), 2,882 (30%) patients were obese and 3,039 (32%) were diagnosed with baseline CKD. A total of 954 (10%) were both obese and diagnosed with CKD. Prevalence of CKD in the renal cohort was 33.1% for obese and 31.7% for nonobese patients. In the CKD subgroup, the rate of major cardiovascular events was significantly higher among obese than nonobese patients (hazard ratio [HR] = 1.59, 95% confidence interval [CI] 1.26-2.01; P < .0001). Among patients with no CKD, obesity did not significantly affect major cardiovascular event rates (P = .15). The investigators found that patients with both obesity and CKD were at significantly greater risk of major cardiovascular events than those with only one of these comorbidities and at significantly greater risk than those with neither comorbidity (HR = 1.92; 95% CI, 1.55-2.36; P < .0001). Notably, and in all CKD and obesity categories except obesity alone, patients treated with ATV 80 mg/day achieved a reduced risk of major cardiovascular events compared with those treated with ATV 10 mg/day. Treatment effect was strongest among CHD patients with obesity and CKD, among whom relative risk of major cardiovascular events significantly fell by 32.5% for ATV 80 versus 10 mg/day (HR = 0.675; 95% CI, 0.49-0.97; P = .03). “We have confirmed here the importance of aggressive lipid lowering in coronary patients with obesity and CKD,” Dr. Deedwania said. Funding for this study was provided by Pfizer. [Presentation title: 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. Abstract 1131-110] E-mail this page to a friend or colleague! To print, use this version