Benefit observed in stroke and TIA patients.


ORLANDO—High-dose atorvastatin may preserve renal function in patients with cerebrovascular disease, a study shows.

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The finding, based on a post hoc analysis of the Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial, was presented here at the American Heart Association 2007 Scientific Sessions. The study population included 4,731 men and women at least 18 years old with a history of hemorrhagic stroke or transient ischemic attack (TIA) without known coronary heart disease.


Follow-up was conducted for a median of 4.9 years. Patients were randomized to receive either atorvastatin 80 mg per day or placebo. The atorvastatin group experienced a reduction in the overall incidence of strokes and cardiovascular events. Initial results were published in the New England Journal of Medicine (2006;355:549-559).


In the post hoc analysis, Vito M. Campese, MD, of the University of Southern California in Los Angeles, and his colleagues analyzed renal data obtained from 4,719 of the patients. They divided patients into two groups according to estimated glomerular filtration rate (eGFR) at baseline. Group 1 comprised 3,119 subjects without CKD (eGFR 60 mL/min/1.73 m2 or higher); group 2 included the remaining 1,600 subjects with CKD (eGFR below 60 mL/min/1.73 m2). Group 2 had older patients and included more women. Patients with CKD had higher mean systolic BP and triglyceride levels and were more likely to be taking antihypertensive medication than group 1.


In both groups, atorvastatin was associated with a significantly greater improvement from baseline in serum creatinine and eGFR compared with placebo, a benefit that was independent of baseline CKD status. Subjects with CKD in both treatment groups, however, exhibited a more notable improvement in eGFR than those without CKD.


In these patients, eGFR increased by about 3 mL/min/1.73 m2 in the atorvastatin-treated patients compared with just over 1.5 mL/min/1.73 m2 in placebo recipients. Also in the CKD patients, serum creatinine declined by about 0.03 mg/dL in the atorvastatin group compared with about 0.015 mg/dL in the placebo recipients.


The investigators also analyzed atorvastatin’s effectiveness according to glycemic status, which can affect renal function. They divided patients into three groups. Group 1 consisted of normoglycemic subjects, group 2 subjects had the metabolic syndrome, and group 3 had type 2 diabetes mellitus. Renal function improved in normoglycemic subjects and in those with the metabolic syndrome. The renal benefit was greater with atorvastatin than with placebo. In diabetic subjects, renal function declined in the placebo-treated group but was preserved in the atorvastatin-treated group. The renal benefits of atorvastatin were achieved without additional adverse effects, regardless of CKD status.