稳定性冠心病患者强化降脂

TNT:

TreatingtoNewTargets治疗达到新目标研究

TNTtrial:

Newdataon

intensivelipidlowering

instableCHDpatients稳定性冠心病患者强化降脂治疗的新数据TNT:TreatingtoNewTargetsLaRosaJCetal.NEnglJMed.2005;352.Hypothesis: LoweringLDL-Clevelstowell

below100mg/dLcouldyield

anincrementalclinicalbenefitParticipants: 10,001patientswithstableCHD

andLDL-C130-250mg/dLTreatments: Atorvastatin10mgand80mgMedianfollow-up: 4.9yearsPrimaryoutcome: CHDdeath,MI,resuscitationafter

cardiacarrest,fatal/nonfatalstrokeBenefitofintensiveLDL-Clowering:AccumulatingevidenceLaRosaJCetal.NEnglJMed.2005;352.030510152025StatinPlaceboHPSCARELIPIDHPSCARELIPID4S4SLDLcholesterol(mg/dL)02101901701501301109070Event

(%)TNT:DesignPatientpopulation250centers

in14countries

(N=10,001)LDL130–250mg/dLTG<600mg/dLAtorvastatin10mgAtorvastatin80mg4.9yearsAtorvastatin10mg8weeksWatersDDetal.AmJCardiol.2004;93:154-8.TNT:BaselinecharacteristicsLaRosaJCetal.NEnglJMed.2005;352.

Atorvastatin Atorvastatin

Characteristics 10mg(N=5006) 80mg(N=4995)Age(yr) 60.9±8.8 61.2±8.8Malesex(%) 80.8 81.2Whiterace(%) 94.1 94.1SystolicBP(mmHg) 131±17 131±17DiastolicBP(mmHg) 78±10 78±10BMI(kg/m2) 28.6±4.7 28.4±4.5TNT:CVhistoryofparticipantsLaRosaJCetal.NEnglJMed.2005;352. %Atorvastatin %Atorvastatin

10mg(N=5006) 80mg(N=4995)Currentsmoker 13.4 13.4Formersmoker 63.3 63.2Systemichypertension 54.4 53.9Diabetesmellitus 15.0 15.0MI 57.7 59.0Angina 81.2 81.8Cerebrovascularevent 5.3 5.1PAD 11.4 12.1CHF 8.1 7.6Arrhythmia 18.5 18.2CoronaryrevascularizationAngioplasty 54.3 53.8

Bypass 46.7 46.4TNT:BaselinelipidsLaRosaJCetal.NEnglJMed.2005;352.

Atorvastatin Atorvastatin

Lipids(mg/dL) 10mg(N=5006) 80mg(N=4995)LDLcholesterol 98±18 97±18Totalcholesterol 175±24 175±24Triglycerides 151±72 151±72HDLcholesterol 47±11 47±11TNT:非心源性死亡率LaRosaJCetal.NEnglJMed.2005;352. %阿托伐他汀 %阿托伐他汀

10mg 80mg 危险比

(N=5006) (N=4995) (95%CI) P癌症 1.5 1.7 1.13(0.83,1.55) 0.42其它非外伤原因 0.9 1.2 1.35(0.91,2.00) 0.13

TNT:对治疗的耐受性LaRosaJCetal.NEnglJMed.2005;352. %阿托伐他汀 %阿托伐他汀

10mg 80mg

(N=5006) (N=4995) P不良反应事件 5.8 8.1 <0.001停药率 5.3 7.2 <0.001肌痛 4.7 4.8 0.72ALT/AST>3xULN 0.2 1.2 <0.001

TNT:降低LDL-C治疗的扩展的确切益处已超越现有指南LaRosaJCetal.NEnglJMed.2005;352.030510152025他汀安慰