Relation Between Change in Renal Function and Cardiovascular Outcomes in Atorvastatin-Treated Patients (From the Treating to New Targets [TNT] Study)
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. Th...
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| Veröffentlicht in: | The American journal of cardiology 2016-04, Vol.117 (8), p.1199-1205 |
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| creator | Shepherd, James, MD Breazna, Andrei, PhD Deedwania, Prakash C., MD LaRosa, John C., MD Wenger, Nanette K., MD Messig, Michael, PhD Wilson, Daniel J., MD |
| description | 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 relationship between intra-study change in estimated glomerular filtration rate (eGFR) from baseline and the risk of major cardiovascular events (MCVE, defined as CHD death, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest or fatal or nonfatal stroke) was assessed among 9500 patients stratified by renal function: improving (change in eGFR >+2 mL/min/1.73m2 ), stable (−2 to +2 mL/min/1.73m2 ), and worsening ( |
| doi_str_mv | 10.1016/j.amjcard.2016.01.014 |
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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 relationship between intra-study change in estimated glomerular filtration rate (eGFR) from baseline and the risk of major cardiovascular events (MCVE, defined as CHD death, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest or fatal or nonfatal stroke) was assessed among 9500 patients stratified by renal function: improving (change in eGFR >+2 mL/min/1.73m2 ), stable (−2 to +2 mL/min/1.73m2 ), and worsening (<−2 mL/min/1.73m2 ). Compared with patients with worsening renal function (1479 patients, 15.6%), the rate of MCVEs was 28% lower among patients with stable renal function (2241 patients, 23.6%) (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.60 to 0.87; P =0.0005), and 64% lower among patients with improving renal function (5780 patients, 60.8%) (HR, 0.36; 95% CI, 0.30 to 0.43; P <0.0001). For each 1-mL/min/1.73 m2 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 m2 increase in eGFR of 2.0% was reported with atorvastatin 10 mg and 3.3% with atorvastatin 80 mg. In conclusion, intra-study stabilization or increase in eGFR in atorvastatin-treated CHD patients 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.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2016.01.014</identifier><identifier>PMID: 26940556</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Atorvastatin Calcium - administration & dosage ; Body mass index ; Cardiovascular ; Cardiovascular disease ; Cause of Death - trends ; Cholesterol ; Confidence intervals ; Coronary Artery Disease - complications ; Coronary Artery Disease - drug therapy ; Coronary Artery Disease - mortality ; Coronary vessels ; Creatinine - blood ; Diabetes ; Dose-Response Relationship, Drug ; Double-Blind Method ; Fees & charges ; Female ; Follow-Up Studies ; Glomerular Filtration Rate - drug effects ; Glomerular Filtration Rate - physiology ; Heart attacks ; Heart failure ; Heart surgery ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage ; Hypertension ; Kidney diseases ; Kidney Function Tests ; Low density lipoprotein ; Male ; Middle Aged ; Mortality ; Prospective Studies ; Renal Insufficiency, Chronic - etiology ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - prevention & control ; Risk Factors ; Rodents ; Survival Rate - trends ; Triglycerides ; United States - epidemiology</subject><ispartof>The American journal of cardiology, 2016-04, Vol.117 (8), p.1199-1205</ispartof><rights>Elsevier Inc.</rights><rights>2016 The Authors</rights><rights>Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 15, 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c561t-6c6fdcbd0c4aa030eafcb799a0d06dcdf78e8a6925c1c1ce5ec2d5bc11e882243</citedby><cites>FETCH-LOGICAL-c561t-6c6fdcbd0c4aa030eafcb799a0d06dcdf78e8a6925c1c1ce5ec2d5bc11e882243</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914916301369$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26940556$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shepherd, James, MD</creatorcontrib><creatorcontrib>Breazna, Andrei, PhD</creatorcontrib><creatorcontrib>Deedwania, Prakash C., MD</creatorcontrib><creatorcontrib>LaRosa, John C., MD</creatorcontrib><creatorcontrib>Wenger, Nanette K., MD</creatorcontrib><creatorcontrib>Messig, Michael, PhD</creatorcontrib><creatorcontrib>Wilson, Daniel J., MD</creatorcontrib><creatorcontrib>Treating to New Targets Steering Committee and Investigators</creatorcontrib><title>Relation Between Change in Renal Function and Cardiovascular Outcomes in Atorvastatin-Treated Patients (From the Treating to New Targets [TNT] Study)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>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 relationship between intra-study change in estimated glomerular filtration rate (eGFR) from baseline and the risk of major cardiovascular events (MCVE, defined as CHD death, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest or fatal or nonfatal stroke) was assessed among 9500 patients stratified by renal function: improving (change in eGFR >+2 mL/min/1.73m2 ), stable (−2 to +2 mL/min/1.73m2 ), and worsening (<−2 mL/min/1.73m2 ). Compared with patients with worsening renal function (1479 patients, 15.6%), the rate of MCVEs was 28% lower among patients with stable renal function (2241 patients, 23.6%) (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.60 to 0.87; P =0.0005), and 64% lower among patients with improving renal function (5780 patients, 60.8%) (HR, 0.36; 95% CI, 0.30 to 0.43; P <0.0001). For each 1-mL/min/1.73 m2 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 m2 increase in eGFR of 2.0% was reported with atorvastatin 10 mg and 3.3% with atorvastatin 80 mg. In conclusion, intra-study stabilization or increase in eGFR in atorvastatin-treated CHD patients 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Atorvastatin Calcium - administration & dosage</subject><subject>Body mass index</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cause of Death - trends</subject><subject>Cholesterol</subject><subject>Confidence intervals</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - drug therapy</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary vessels</subject><subject>Creatinine - blood</subject><subject>Diabetes</subject><subject>Dose-Response Relationship, Drug</subject><subject>Double-Blind Method</subject><subject>Fees & charges</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Glomerular Filtration Rate - physiology</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart surgery</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</subject><subject>Hypertension</subject><subject>Kidney diseases</subject><subject>Kidney Function Tests</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency, Chronic - etiology</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Renal Insufficiency, Chronic - prevention & control</subject><subject>Risk Factors</subject><subject>Rodents</subject><subject>Survival Rate - trends</subject><subject>Triglycerides</subject><subject>United States - epidemiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkt9qFDEUxoModlt9BCXgTXsxazJ_MpMbS11cFUor7XglErLJmW3WmaQmmZZ9EN_XTHdV6I3kQDicX75DzncQekXJnBLK3m7mctgo6fU8T-mc0BTlEzSjTc0zymnxFM0IIXnGackP0GEIm5RSWrHn6CBnvCRVxWbo1xX0Mhpn8XuI9wAWL26kXQM2Fl-BlT1ejlY9ANJqvEgNjbuTQY299PhyjMoNECb6LDqfCjGp2az1ICNo_CVlYGPAx0vvBhxvAD-UjF3j6PAF3ONW-jUk4lt70X7H13HU25MX6Fkn-wAv9_cR-rr80C4-ZeeXHz8vzs4zVTEaM6ZYp9VKE1VKSQoCslOrmnNJNGFa6a5uoJGM55Wi6UAFKtfVSlEKTZPnZXGEjne6t979HCFEMZigoO-lBTcGQeu6JjUv2IS-eYRu3OjTgHZUzlhdkURVO0p5F4KHTtx6M0i_FZSIyTexEXvfxOSbIDTFpP56rz6uBtB_X_0xKgGnOwDSOO4MeBFUmqwCbTyoKLQz_23x7pGC6o01SvY_YAvh329EyAUR19PyTLtDWUFowXjxG3Ktwl4</recordid><startdate>20160415</startdate><enddate>20160415</enddate><creator>Shepherd, James, MD</creator><creator>Breazna, Andrei, PhD</creator><creator>Deedwania, Prakash C., MD</creator><creator>LaRosa, John C., MD</creator><creator>Wenger, Nanette K., MD</creator><creator>Messig, Michael, PhD</creator><creator>Wilson, Daniel J., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20160415</creationdate><title>Relation Between Change in Renal Function and Cardiovascular Outcomes in Atorvastatin-Treated Patients (From the Treating to New Targets [TNT] Study)</title><author>Shepherd, James, MD ; Breazna, Andrei, PhD ; Deedwania, Prakash C., MD ; LaRosa, John C., MD ; Wenger, Nanette K., MD ; Messig, Michael, PhD ; Wilson, Daniel J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c561t-6c6fdcbd0c4aa030eafcb799a0d06dcdf78e8a6925c1c1ce5ec2d5bc11e882243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Atorvastatin Calcium - administration & dosage</topic><topic>Body mass index</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cause of Death - trends</topic><topic>Cholesterol</topic><topic>Confidence intervals</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - drug therapy</topic><topic>Coronary Artery Disease - mortality</topic><topic>Coronary vessels</topic><topic>Creatinine - blood</topic><topic>Diabetes</topic><topic>Dose-Response Relationship, Drug</topic><topic>Double-Blind Method</topic><topic>Fees & charges</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Glomerular Filtration Rate - physiology</topic><topic>Heart attacks</topic><topic>Heart failure</topic><topic>Heart surgery</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage</topic><topic>Hypertension</topic><topic>Kidney diseases</topic><topic>Kidney Function Tests</topic><topic>Low density lipoprotein</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency, Chronic - 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Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shepherd, James, MD</au><au>Breazna, Andrei, PhD</au><au>Deedwania, Prakash C., MD</au><au>LaRosa, John C., MD</au><au>Wenger, Nanette K., MD</au><au>Messig, Michael, PhD</au><au>Wilson, Daniel J., MD</au><aucorp>Treating to New Targets Steering Committee and Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relation Between Change in Renal Function and Cardiovascular Outcomes in Atorvastatin-Treated Patients (From the Treating to New Targets [TNT] Study)</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2016-04-15</date><risdate>2016</risdate><volume>117</volume><issue>8</issue><spage>1199</spage><epage>1205</epage><pages>1199-1205</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>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 relationship between intra-study change in estimated glomerular filtration rate (eGFR) from baseline and the risk of major cardiovascular events (MCVE, defined as CHD death, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest or fatal or nonfatal stroke) was assessed among 9500 patients stratified by renal function: improving (change in eGFR >+2 mL/min/1.73m2 ), stable (−2 to +2 mL/min/1.73m2 ), and worsening (<−2 mL/min/1.73m2 ). Compared with patients with worsening renal function (1479 patients, 15.6%), the rate of MCVEs was 28% lower among patients with stable renal function (2241 patients, 23.6%) (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.60 to 0.87; P =0.0005), and 64% lower among patients with improving renal function (5780 patients, 60.8%) (HR, 0.36; 95% CI, 0.30 to 0.43; P <0.0001). For each 1-mL/min/1.73 m2 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 m2 increase in eGFR of 2.0% was reported with atorvastatin 10 mg and 3.3% with atorvastatin 80 mg. In conclusion, intra-study stabilization or increase in eGFR in atorvastatin-treated CHD patients 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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26940556</pmid><doi>10.1016/j.amjcard.2016.01.014</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Atorvastatin Calcium - administration & dosage Body mass index Cardiovascular Cardiovascular disease Cause of Death - trends Cholesterol Confidence intervals Coronary Artery Disease - complications Coronary Artery Disease - drug therapy Coronary Artery Disease - mortality Coronary vessels Creatinine - blood Diabetes Dose-Response Relationship, Drug Double-Blind Method Fees & charges Female Follow-Up Studies Glomerular Filtration Rate - drug effects Glomerular Filtration Rate - physiology Heart attacks Heart failure Heart surgery Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Hypertension Kidney diseases Kidney Function Tests Low density lipoprotein Male Middle Aged Mortality Prospective Studies Renal Insufficiency, Chronic - etiology Renal Insufficiency, Chronic - physiopathology Renal Insufficiency, Chronic - prevention & control Risk Factors Rodents Survival Rate - trends Triglycerides United States - epidemiology |
| title | Relation Between Change in Renal Function and Cardiovascular Outcomes in Atorvastatin-Treated Patients (From the Treating to New Targets [TNT] Study) |
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