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)

Abstract

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.

Assessment of Lipophilic vs. Hydrophilic Statin Therapy in Acute Myocardial Infarction

“…26 A post-hoc analysis of the TNT trial recently showed that improvement in kidney function might be related to the beneficial effect of high-dose atorvastatin on heart failure hospitalization. 27 In the present study, however, no definite benefit was seen with regard to change in creatinine and BNP in the atorvastatin group. In contrast, pravastatin appeared to preserve kidney function, showing no increase in serum creatinine level, as compared with the modest increase in the atorvastatin group.…”

Stiff Heart and Stiff Arteries. Could We Soften Both?

“…Therefore, the reduced risk for hospitalization for HF appears to be partly mediated by the improvement of renal function related to atorvastatin treatment [115]. These results are supported by the TNT findings [116], according to which improvement in kidney function may contribute to the beneficial effects of high-dose atorvastatin on HF hospitalization [116]. These findings suggest that the effects of statins in HF depend on the compound and dose used.…”

Atrial Heterogeneous Autonomic Neural Remodeling in Rabbits with Experimental Atrial Fibrillation and the Effect of Intervention by Rosuvastatin

“…Recent studies have demonstrated the many other biological effects of statins. Moreover, massive clinical trials showed that statins are safe and effective in primary and secondary prevention of cardiovascular diseases and can significantly reduce fatality and total mortality rates of cardiovascular disease . Yu et al .…”