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Effects of atorvastatin on kidney outcomes and cardiovascular disease in patients with diabetes: an analysis from the Collaborative Atorvastatin Diabetes Study (CARDS).
Am J Kidney Dis. 2009 Nov; 54(5):810-9.AJ

Abstract

BACKGROUND

We examined whether atorvastatin affects diabetic kidney disease and whether the effect of atorvastatin on cardiovascular disease (CVD) varies by kidney status in patients with diabetes.

STUDY DESIGN

The Collaborative Atorvastatin Diabetes Study (CARDS) randomized placebo-controlled trial.

SETTING & PARTICIPANTS

Patients with type 2 diabetes and no prior CVD (n = 2,838).

INTERVENTION

Random allocation to atorvastatin, 10 mg/d, or placebo, with a median follow-up of 3.9 years.

OUTCOMES

Estimated glomerular filtration rate (eGFR), albuminuria, CVD.

MEASUREMENTS

Baseline and follow-up GFRs were estimated by using the Modification of Diet in Renal Disease Study equation. Urinary albumin-creatinine ratio was measured on spot urine samples.

RESULTS

At baseline, 34% of patients had an eGFR of 30 to 60 mL/min/1.73 m(2). Atorvastatin treatment was associated with a modest improvement in annual change in eGFR (net, 0.18 mL/min/1.73 m(2)/y; 95% confidence interval [CI], 0.04 to 0.32; P = 0.01) that was most apparent in those with albuminuria (net improvement, 0.38 mL/min/1.73 m(2)/y; P = 0.03). At baseline, 21.5% of patients had albuminuria and an additional 6.8% developed albuminuria during follow-up. Atorvastatin did not influence the incidence of albuminuria (hazard ratio, 1.49; 95% CI, 0.73 to 3.04; P = 0.3) or regression to normoalbuminuria (hazard ratio, 1.19; 95% CI, 0.57 to 2.49; P = 0.6). In 970 patients with a moderately decreased eGFR of 30 to 60 mL/min/1.73 m(2), there was a 42% reduction in major CVD events with treatment, including a 61% reduction in stroke. This treatment effect was similar to the 37% (95% CI, 17 to 52; P < 0.001) reduction in CVD observed in the study overall (P = 0.4 for the eGFR-treatment interaction).

LIMITATIONS

Low incidence rates of albuminuria and transition to more severe kidney status limit power to detect treatment effects.

CONCLUSIONS

A modest beneficial effect of atorvastatin on eGFR, particularly in those with albuminuria, was observed. Atorvastatin did not influence albuminuria incidence. Atorvastatin was effective at decreasing CVD in those with and without a moderately decreased eGFR and achieved a high absolute benefit.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Colhoun HM
Biomedical Research Institute, University of Dundee, Dundee, Scotland, UK. h.colhoun@cpse.dundee.ac.uk
Betteridge DJ
No affiliation info available
Durrington PN
No affiliation info available
Hitman GA
No affiliation info available
Neil HA
No affiliation info available
Livingstone SJ
No affiliation info available
Charlton-Menys V
No affiliation info available
DeMicco DA
No affiliation info available
Fuller JH
No affiliation info available
CARDS Investigators
No affiliation info available

MeSH

AgedAlbuminuriaAtorvastatinCardiovascular DiseasesDiabetes Mellitus, Type 2Diabetic NephropathiesFemaleGlomerular Filtration RateHeptanoic AcidsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPyrroles

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19540640

Clinical Trial Links

Clinical trial which this article describes

Citation

Colhoun, Helen M., et al. "Effects of Atorvastatin On Kidney Outcomes and Cardiovascular Disease in Patients With Diabetes: an Analysis From the Collaborative Atorvastatin Diabetes Study (CARDS)." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 54, no. 5, 2009, pp. 810-9.
Colhoun HM, Betteridge DJ, Durrington PN, et al. Effects of atorvastatin on kidney outcomes and cardiovascular disease in patients with diabetes: an analysis from the Collaborative Atorvastatin Diabetes Study (CARDS). Am J Kidney Dis. 2009;54(5):810-9.
Colhoun, H. M., Betteridge, D. J., Durrington, P. N., Hitman, G. A., Neil, H. A., Livingstone, S. J., Charlton-Menys, V., DeMicco, D. A., & Fuller, J. H. (2009). Effects of atorvastatin on kidney outcomes and cardiovascular disease in patients with diabetes: an analysis from the Collaborative Atorvastatin Diabetes Study (CARDS). American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 54(5), 810-9. https://doi.org/10.1053/j.ajkd.2009.03.022
Colhoun HM, et al. Effects of Atorvastatin On Kidney Outcomes and Cardiovascular Disease in Patients With Diabetes: an Analysis From the Collaborative Atorvastatin Diabetes Study (CARDS). Am J Kidney Dis. 2009;54(5):810-9. PubMed PMID: 19540640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of atorvastatin on kidney outcomes and cardiovascular disease in patients with diabetes: an analysis from the Collaborative Atorvastatin Diabetes Study (CARDS). AU - Colhoun,Helen M, AU - Betteridge,D John, AU - Durrington,Paul N, AU - Hitman,Graham A, AU - Neil,H Andrew W, AU - Livingstone,Shona J, AU - Charlton-Menys,Valentine, AU - DeMicco,David A, AU - Fuller,John H, AU - ,, Y1 - 2009/06/21/ PY - 2008/12/05/received PY - 2009/03/27/accepted PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2009/11/17/medline SP - 810 EP - 9 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 54 IS - 5 N2 - BACKGROUND: We examined whether atorvastatin affects diabetic kidney disease and whether the effect of atorvastatin on cardiovascular disease (CVD) varies by kidney status in patients with diabetes. STUDY DESIGN: The Collaborative Atorvastatin Diabetes Study (CARDS) randomized placebo-controlled trial. SETTING & PARTICIPANTS: Patients with type 2 diabetes and no prior CVD (n = 2,838). INTERVENTION: Random allocation to atorvastatin, 10 mg/d, or placebo, with a median follow-up of 3.9 years. OUTCOMES: Estimated glomerular filtration rate (eGFR), albuminuria, CVD. MEASUREMENTS: Baseline and follow-up GFRs were estimated by using the Modification of Diet in Renal Disease Study equation. Urinary albumin-creatinine ratio was measured on spot urine samples. RESULTS: At baseline, 34% of patients had an eGFR of 30 to 60 mL/min/1.73 m(2). Atorvastatin treatment was associated with a modest improvement in annual change in eGFR (net, 0.18 mL/min/1.73 m(2)/y; 95% confidence interval [CI], 0.04 to 0.32; P = 0.01) that was most apparent in those with albuminuria (net improvement, 0.38 mL/min/1.73 m(2)/y; P = 0.03). At baseline, 21.5% of patients had albuminuria and an additional 6.8% developed albuminuria during follow-up. Atorvastatin did not influence the incidence of albuminuria (hazard ratio, 1.49; 95% CI, 0.73 to 3.04; P = 0.3) or regression to normoalbuminuria (hazard ratio, 1.19; 95% CI, 0.57 to 2.49; P = 0.6). In 970 patients with a moderately decreased eGFR of 30 to 60 mL/min/1.73 m(2), there was a 42% reduction in major CVD events with treatment, including a 61% reduction in stroke. This treatment effect was similar to the 37% (95% CI, 17 to 52; P < 0.001) reduction in CVD observed in the study overall (P = 0.4 for the eGFR-treatment interaction). LIMITATIONS: Low incidence rates of albuminuria and transition to more severe kidney status limit power to detect treatment effects. CONCLUSIONS: A modest beneficial effect of atorvastatin on eGFR, particularly in those with albuminuria, was observed. Atorvastatin did not influence albuminuria incidence. Atorvastatin was effective at decreasing CVD in those with and without a moderately decreased eGFR and achieved a high absolute benefit. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/19540640/Effects_of_atorvastatin_on_kidney_outcomes_and_cardiovascular_disease_in_patients_with_diabetes:_an_analysis_from_the_Collaborative_Atorvastatin_Diabetes_Study__CARDS__ DB - PRIME DP - Unbound Medicine ER -
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