Intensive Lipid Lowering With Atorvastatin in Patients With Coronary Heart Disease and Chronic Kidney DiseaseThe TNT (Treating to New Targets) Study
James Shepherd, MD*,*,
John J.P. Kastelein, MD, PhD ,
Vera Bittner, MD, FACC ,
Prakash Deedwania, MD, FACC ,
Andrei Breazna, PhD||,
Stephen Dobson, BSc¶,
Daniel J. Wilson, MD||,
Andrea Zuckerman, MD||,
Nanette K. Wenger, MD, FACC# for the TNT (Treating to New Targets) Investigators
* University of Glasgow, Glasgow, United Kingdom
Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
University of Alabama at Birmingham, Birmingham, Alabama
VA Central California Healthcare System and UCSF School of Medicine, Fresno, California
|| Pfizer Inc., New York, New York
¶ Envision Pharma Ltd., Horsham, United Kingdom
# Emory University School of Medicine, Atlanta, Georgia.
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Figure 2 Time to First Major CV Event by Treatment in Patients With CKD and With Normal eGFR at Baseline
In patients with chronic kidney disease (CKD) at baseline, intensive lipid lowering with atorvastatin 80 mg resulted in a 32% relative reduction in risk of major cardiovascular (CV) events compared with atorvastatin 10 mg (p = 0.0003). In patients with normal or near-normal estimated glomerular filtration rate (eGFR) at baseline, a smaller but significant 15% relative reduction in risk of major CV events was observed with atorvastatin 80 mg (p = 0.049). ARR = absolute risk reduction; CI = confidence interval; HR = hazard ratio; NNT = number needed to treat.
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Figure 3 Primary and Secondary Event Rates in Patients With CKD and Patients With Normal eGFR
For all predefined secondary end points, event rates were higher in CKD patients than in patients with normal eGFR. In patients with CKD, treatment with atorvastatin 80 mg resulted in significant reductions, compared with atorvastatin 10 mg, in the risk of the following secondary outcomes: any cardiovascular event, major coronary event, any coronary event, cerebrovascular event, and congestive heart failure with hospitalization. *All patients randomized in the TNT study (includes 345 patients without complete renal data). TNT = Treating to New Targets study; other abbreviations as in Figure 2.
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