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1、TNT: Treating to New Targets治疗达到新目标研究,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 well below 100 mg/dL could yield an incremental clinical benefi
2、t Participants: 10,001 patients with stable CHD and 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 after cardiac arrest, fatal/nonfatal stroke,Benefit of intensive LDL-C lowering: Accumulating evidence,LaRosa JC
3、et al. N Engl J Med. 2005;352.,0,30,5,10,15,20,25,Statin,Placebo,HPS,CARE,LIPID,HPS,CARE,LIPID,4S,4S,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
4、 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) 60.98.8 61.28.8 Male sex (%) 80.8 81.2 White race (%)
5、94.1 94.1 Systolic BP (mm Hg) 13117 13117 Diastolic BP (mm Hg) 7810 7810 BMI (kg/m2) 28.64.7 28.44.5,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 smoker 13.4 13.4 Former smoker 63.3 63.2 Systemic hype
6、rtension 54.4 53.9 Diabetes mellitus 15.0 15.0 MI 57.7 59.0 Angina 81.2 81.8 Cerebrovascular event 5.3 5.1 PAD 11.4 12.1 CHF 8.1 7.6 Arrhythmia 18.5 18.2 Coronary revascularization Angioplasty 54.3 53.8 Bypass 46.7 46.4,TNT: Baseline lipids,LaRosa JC et al. N Engl J Med. 2005;352.,Atorvastatin Atorv
7、astatin Lipids (mg/dL) 10 mg (N = 5006) 80 mg (N = 4995) LDL cholesterol 9818 9718 Total cholesterol 17524 17524 Triglycerides 15172 15172 HDL cholesterol 4711 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 1.5 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,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 不良反应事件 5.8 8.1 3x ULN 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,LaRosa JC et al. N Engl J Med. 2005;352.,事件(%),,