Clinical insights from the Treating to New Targets trial.
The Treating to New Targets (TNT) trial enrolled 10,001 patients with coronary disease to treatment with atorvastatin, 80 or 10 mg/d, and observed them for a median of 4.9 years. Mean low-density lipoprotein cholesterol (LDL-C) levels were 77 mg/dL in the 80-mg group and 101 mg/dL in the 10-mg group. The primary end point, a composite of cardiovascular death, myocardial infraction, resuscitated cardiac arrest, and stroke, occurred in 10.9% of patients in the 10-mg and 8.7% of patients in the 80-mg group (P = .0002). In large subgroups of patients in TNT, specifically those with diabetes, the metabolic syndrome, chronic kidney disease, or previous coronary bypass (CABG) surgery, the risk of an event was significantly higher than in patients without these features. The absolute risk reduction in the 80-mg group was greater in each of these subgroups than in other TNT patients. The rates of stroke and hospitalization for heart failure were significantly lower in the more aggressively treated patients. A total of 18,696 patients have taken 80 mg of atorvastatin in clinical trials, usually for 4 to 5 years, with an excellent safety record. Pharmacoeconomic studies indicate that treatment with the 80-mg dose instead of the 10-mg dose almost costs neutral in US TNT-like patients (additional cost $181 for 5 years). In summary, wider use of the 80-mg dose of atorvastatin in patients with stable coronary disease is safe, cost-effective, and provides an incremental reduction in coronary events.
Division of Cardiology, San Francisco General Hospital, University of California, San Francisco, CA, USA. dwaters@medsfgh.ucsf.edu
David D
DD
Waters
D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006973:Hypertension / Q000453:epidemiology; D024821:Metabolic Syndrome / Q000453:epidemiology; D011758:Pyrroles / Q000008:administration & dosage*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors
D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin