Lower is better: implications of the Treating to New Targets (TNT) study for Canadian patients.
Recent clinical trials have indicated that lowering low-density lipoprotein cholesterol (LDL-C) levels below currently recommended targets results in favourable surrogate and clinical end points. The Treating to New Targets (TNT) study now confirms that aggressive cholesterol lowering to a mean LDL-C of 2.0 mmol/L with atorvastatin 80 mg daily, compared with the previous target of 2.5 mmol/L with atorvastatin 10 mg daily, results in improved clinical outcomes in high-risk patients with coronary artery disease. A lower LDL-C target of less than 2.0 mmol/L will present therapeutic challenges, because approximately only one-half of high-risk patients will achieve this target using monotherapy with the newer and more powerful statins. Furthermore, registry data show that one-half of these patients are not even achieving the current LDL-C target of 2.5 mmol/L. Causes of the care gap are discussed and possible remedies to achieve the new lower targets are suggested.
Fitchett
David H
DH
Division of Cardiology, St. Michael's Hospital, Toronto, Ontario. fitchettd@smh.toronto.on.ca
Leiter
Lawrence A
LA
Goodman
Shaun G
SG
Langer
Anatoly
A
D000069059:Atorvastatin; D002170:Canada / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000517:prevention & control; D011758:Pyrroles / Q000008:administration & dosage / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control
D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D000960:Hypolipidemic Agents; D011758:Pyrroles; D000069059:Atorvastatin