稳定性冠心病患者强化降脂

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,TNT:,Treating to New Targets治疗到达新目标研究,TNT trial:,New data on intensive lipid lowering in stable CHD patients,稳定性冠心病患者强化降脂,治疗的新数据,TNT:Treating to New Targets,LaRosa JC et al.,N Engl J Med.,2005;352.,Hypothesis:,Lowering LDL-C levels to wellbelow 100 mg/dL could yield an incremental clinical benefit,Participants:,10,001 patients with stable CHDand LDL-C 130-250 mg/dL,Treatments:,Atorvastatin 10 mg and 80 mg,Median follow-up:,4.9 years,Primary outcome:,CHD death,MI,resuscitation aftercardiac arrest,fatal/nonfatal stroke,Benefit of intensive LDL-C lowering:Accumulating evidence,LaRosa JC et al.,N Engl J Med.,2005;352.,0,30,5,10,15,20,25,Statin,Placebo,HPS,CARE,LIPID,HPS,CARE,LIPID,4,S,4,S,LDL cholesterol(mg/dL),0,210,190,170,150,130,110,90,70,Event(%),TNT:Design,Patient population,250 centers in 14 countries(N=10,001),LDL 130250 mg/,dL,TG 600 mg/,dL,Atorvastatin 10 mg,Atorvastatin 80 mg,4.9,years,Atorvastatin 10 mg,8,weeks,Waters DD et al.,Am J Cardiol.,2004;93:154-8.,TNT:Baseline characteristics,LaRosa JC et al.,N Engl J Med.,2005;352.,Atorvastatin Atorvastatin Characteristics 10 mg(N=5006)80 mg(N=4995),Age(yr)60.98.861.28.8,Male sex(%)80.881.2,White race(%)94.194.1,Systolic BP(mm Hg)1311713117,Diastolic BP(mm Hg)7810 7810,BMI(kg/m,2,)28.64.728.44.5,TNT:CV history of participants,LaRosa JC et al.,N Engl J Med.,2005;352.,%,Atorvastatin%Atorvastatin 10 mg(N=5006)80 mg(N=4995),Current smoker13.413.4,Former smoker63.363.2,Systemic hypertension54.453.9,Diabetes mellitus15.015.0,MI57.759.0,Angina81.281.8,Cerebrovascular event5.35.1,PAD11.412.1,CHF8.17.6,Arrhythmia18.518.2,Coronary revascularization,Angioplasty54.353.8 Bypass46.746.4,TNT:Baseline lipids,LaRosa JC et al.,N Engl J Med.,2005;352.,Atorvastatin Atorvastatin Lipids(mg/dL)10 mg(N=5006)80 mg(N=4995),LDL cholesterol98189718,Total cholesterol17524 17524,Triglycerides15172 15172,HDL cholesterol4711 4711,TNT:,非心源性死亡率,LaRosa JC et al.,N Engl J Med.,2005;352.,%阿托伐他汀%阿托伐他汀 10,mg 80 mg,危险比(,N=5006)(N=4995)(95%CI)P,癌症1.51.71.13(0.83,1.55)0.42,其它非外伤原因0.91.21.35(0.91,2.00)0.13,TNT:,对治疗的耐受性,LaRosa JC et al.,N Engl J Med.,2005;352.,%阿托伐他汀%阿托伐他汀 10 mg 80 mg(N=5006)(N=4995)P,不良反响事件5.88.1 0.001,停药率5.37.2 3x ULN0.21.20.001,TNT:降低LDL-C治疗的扩展确实切益处 已超越现有指南,LaRosa JC et al.,N Engl J Med.,2005;352.,0,30,5,10,15,20,25,他汀,安慰剂,HPS,CARE,LIPID,HPS,CARE,LIPID,4,S,4,S,LDL,胆固醇(,mg/dL),0,210,190,170,150,130,110,90,70,TNT(80 mg,阿托伐他汀),TNT(10 mg,阿托伐他汀),事件(%),