Relation of Improvement in Estimated Glomerular Filtration Rate With Atorvastatin to Reductions in Hospitalizations for Heart Failure (from the Treating to New Targets [TNT] Study) - 30/05/12
, Allison Kean, MD c, Daniel J. Wilson, MD c, David A. DeMicco, PharmD c, Andrei Breazna, PhD c, Chuan-Chuan Wun, PhD c, Prakash C. Deedwania, MD d, Kiran K. Khush, MD, MAS eTNT Investigators
Résumé |
Impaired kidney function often accompanies heart failure (HF) and is associated with a worse prognosis. This post hoc analysis of the Treating to New Targets (TNT) trial examined whether the observed decrease in HF hospitalizations with high- compared to low-dose atorvastatin could be related to improvements in kidney function. Of 10,001 TNT participants, 9,376 had estimated glomerular filtration rate (eGFR) measurements at baseline and 1 year and were included in this analysis. The association of change in year-1 eGFR and subsequent HF hospitalization was examined using Cox regression models. In total 218 participants developed subsequent HF hospitalization. Little change in eGFR occurred over 1 year in the atorvastatin 10-mg group, whereas eGFR improved in the 80-mg group by 1.48 ml/min/1.73 m2 (95% confidence interval 1.29 to 1.67, p <0.0001). Subsequent HF was preceded by a decrease in eGFR over 1 year compared to modest improvement in those without subsequent HF (−0.09 ± 7.89 vs 0.81 ± 6.90 ml/min/1.73 m2, p = 0.0015). After adjusting for baseline eGFR, each 5-ml/min/1.73 m2 increase in eGFR at 1 year was associated with a lower risk of subsequent HF hospitalization (hazard ratio 0.85, 95% confidence interval 0.77 to 0.94, p = 0.002). This relation was independent of treatment effect or change in low-density lipoprotein cholesterol level at 1 year. In conclusion, treatment with high- compared to low-dose atorvastatin was associated with improvement in eGFR at 1 year, which was related to a decrease in subsequent HF hospitalization. This suggests that improvement in kidney function may be related to the beneficial effect of high-dose atorvastatin on HF hospitalization.
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| The Treating to New Targets trial was funded by Pfizer Pharmaceuticals, Inc., New York, New York. Dr. Ho and Dr. Khush have served as consultants for Pfizer Pharmaceuticals. Dr. Waters has served as a consultant for Anthera, Hayward, California, Aegerion, Cambridge, Massachusetts, Biosante, Lincolnshire, Illinois, Cerenis, Ann Arbor, Missouri, CSL, Ltd., Parkville, Victoria, Australia, Genentech, South San Francisco, California, Merck-Schering Plough, Whitehouse Station, New Jersey, Pfizer Pharmaceuticals, Roche, Basel, Switzerland, Sanofi-Aventis, Paris, France, and Servier and has received honoraria for lectures from Pfizer Pharmaceuticals, and Bristol-Myers Squibb, New York, New York. Dr. Deedwania has received honoraria for lectures and has served as a consultant for Pfizer Pharmaceuticals and AstraZeneca, London, UK. |
Vol 109 - N° 12
P. 1761-1766 - juin 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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