ALLIANCE (Analysis of Aggressive Lipid-Lowering Initiation Abates New Cardiac Events)

18 Mar, 14

ALLIANCE

Background

Intensive atorvastatin therapy significantly reduces CV events vs. usual care in patients with CHD and CKD: Analysis of ALLIANCE study

Aim

To investigate the effects of focused atorvastatin therapy on cardiovascular (CV) outcomes in patients with coronary heart disease (CHD) and chronic kidney disease (CKD)

Methods

Analysis of Aggressive Lipid-Lowering Initiation Abates New Cardiac Events (ALLIANCE) study

Patients

CHD with CKD (N= 579)

Study Groups

Focused atorvastatin therapy: Atorvastatin initiated at 10 mg/day and titrated till 80 mg/day or LDL < 80 mg/dl (N=286)
Usual care group: Any treatment thought appropriate by the physician, including statins (N= 293)

Mean Follow-up Period

51.5 months

Primary Outcome

CV events defined as composite of cardiac death, non-fatal myocardial infarction (MI), resuscitated cardiac arrest, cardiac revascularization & unstable angina requiring hospitalization

Results

Atorvastatin therapy significantly reduced the risk of CV events by 28% vs. usual care(Figure 1)

Figure 1. Incidence of CV events

Risk of nonfatal MI, cardiac revascularization and combined end-point of nonfatal MI and cardiac death were significantly reduced with atorvastatin therapy (Figure 2)

Figure 2. Effect of atorvastatin therapy on other CV outcomes

Atorvastatin therapy yielded significantly greater reductions in LDL cholesterol as compared to usual care(34.5% vs. 24.2% with usual care)
Greater improvement in estimated glomerular filtration rate (eGFR) was observed in atorvastatin recipients (2.31 mL/min/1.73m²) vs. usual care (0.2 mL/min/1.73m²)

Safety

Incidence of adverse events was similar in both groups, with no cases of myopathy or rhabdomyolysis in either group
No atorvastatin-treated patients showed creatinine kinase levels >10 times upper limit of normal

Conclusions

Focused atorvastatin therapy significantly reduces CV risk in patients with CHD and CKD vs. usual care
Findings support the use of an intensive statin regimen to provide maximal benefits in preventing CV events in patients with CHD and CKD

Am J Kidney Dis 2009:53:741-50