Focused Atorvastatin Therapy in Managed-Care Patients With Coronary Heart Disease and CKD
Abstract
Background This post hoc analysis of the Aggressive Lipid-Lowering Initiation Abates New Cardiac Events (ALLIANCE) Study investigates the effect of focused atorvastatin therapy versus usual care on cardiovascular outcomes in patients with coronary heart disease (CHD) with and without chronic kidney disease (CKD).Study design Prospective randomized open-label; median follow-up, 54.3 months.Setting & participants Managed care or Veterans Affairs facilities; 2,442 patients with CHD with dyslipidemia; mean age, 61.6 years.Intervention Focused atorvastatin therapy to a low-density lipoprotein cholesterol goal of less than 80 mg/dL or maximum dose of 80 mg/d versus usual care as deemed appropriate by patients' regular physicians.Predictor Baseline estimated glomerular filtration rate (eGFR) calculated using the Modification of Diet in Renal Disease Study equation of less than 60 mL/min/1.73 m(2) (patients with CKD) and 60 mL/min/1.73 m(2) or greater (patients without CKD).Outcomes & measurements The primary end point was time to first cardiovascular event. Change from baseline eGFR was assessed in 1,768 patients with follow-up renal data.Results At baseline, 579 patients (23.7%) had CKD: 31.6% of these patients experienced a primary cardiovascular event during the study versus 23.6% of patients without CKD (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.18 to 1.68; P < 0.001). Compared with usual care, atorvastatin therapy reduced the relative risk of a primary outcome by 28% in patients with CKD (HR, 0.72; 95% CI, 0.54 to 0.97; P = 0.02) and 11% in patients without CKD (HR, 0.89; 95% CI, 0.74 to 1.07; P = 0.3) (P for treatment by CKD interaction = 0.2). There was no decrease in eGFR in atorvastatin-treated patients during the course of the study.Limitations Follow-up of atorvastatin patients was restricted to every 6 months; interim data were unavailable for usual-care patients.Conclusions Patients with CHD and CKD are at increased risk of cardiovascular events. Compared with usual care, focused atorvastatin treatment decreased cardiovascular risk for established patients in real-world settings, with no significant difference in treatment effects observed between patients with and without CKD.
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In those post hoc analyses, suppressive effects of statins on cerebrovascular diseases were not demonstrated.
“However, suppressive effects on cerebrovascular diseases were not demonstrated.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [771]
In patients with CKD complicated with CAD, post hoc analyses of early-stage secondary prevention studies using statins have reported that statin use suppresses cardiovascular events in patients with mild CKD and an eGFR < 75 mL/min/1.73 m2.
“These analyses have reported that statin use suppresses cardiovascular events in patients with mild CKD and an eGFR < 75 mL/min/1.73 m2 771, 772).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [771]
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- Authors
- Koren, M. J., Davidson, M. H., Wilson, D. J., Fayyad, R. S., Zuckerman, A., & Reed, D. P.
- Affiliations
- Jacksonville Center for Clinical Research (US)
- University of Chicago (US)
- Pfizer (United States) (US)
- Corresponding author
- Koren, Michael J.
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2009-05
- Volume
- 53
- Issue
- 5
- Pages
- 741-750
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W1979397038
- Cited by
- 115
- References
- 28
- Citations by year
- 2025: 4 · 2024: 4 · 2023: 5 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 8 · 2018: 5 · 2017: 3 · 2016: 8 · 2015: 10 · 2014: 8 · 2013: 9 · 2012: 12
- FWCI
- 12.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- atorvastatin, coronary artery disease, chronic kidney disease, LDL cholesterol lowering, cardiovascular events, estimated glomerular filtration rate, statin therapy, managed care, dyslipidemia, renal safety, veterans, cardiovascular risk reduction, renal function preservation, cardiovascular risk stratification
- MeSH terms
- Atorvastatin, Aged, Coronary Disease, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Glomerular Filtration Rate, Health Maintenance Organizations, Heptanoic Acids, Humans, Kidney Failure, Chronic, Cholesterol, LDL, Male, Middle Aged, Prospective Studies, Pyrroles, Time Factors, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Dyslipidemias
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