TNT研究和WHS研究PPT课件.pptVIP

TNT and WHS: Twists and turns at the 2005 ACC Eric J Topol MD Provost and Chief Academic Officer Chair, Department of Cardiovascular Medicine Cleveland Clinic Foundation Cleveland, OH Robert M Califf MD Professor of Medicine Associate Vice Chancellor for Clinical Research Director, Duke Clinical Research Institute Duke University Medical Center Durham, NC Topics Treating to new targets Parallel-group study randomizing stable CHD patients to a double-blind treatment with atorvastatin 10 mg or 80 mg (N Engl J Med 2005; published March 8) Study aim Primary hypothesis of TNT was that an incremental reduction in risk could be achieved by lowering LDL-cholesterol levels beyond the currently recommended minimum targets Design 10 001 patients with clinically evident CHD, defined as previous MI, previous or present angina with evidence of atherosclerotic CHD, or having undergone a coronary revascularization procedure Median follow-up of 4.9 years Baseline and final LDL-cholesterol levels Primary efficacy outcomes Califfs conclusions Safety Slightly higher rate of liver-function-test abnormalities 1.2% of patients treated with 80-mg atorvastatin had a persistent elevation in alanine aminotransferase, aspartate aminotransferase, or both, compared with 0.2% of patients treated with 10-mg atorvastatin (p0.001) Cautious editorial Topols thoughts Conspiracy theories Involving CRP reductions Mortality data Remaining questions Decision Womens Health Study: Design Use of aspirin for primary prevention in women (N Engl J Med 2005: published March 7) 39 876 initially healthy women 45 years of age or older Randomized to 100 mg of aspirin on alternate days or placebo Monitored for first major CV event (nonfatal MI, nonfatal stroke, or death from CV causes) 10-year follow-up Cardiovascular end points Stroke end points Misleading results One thumb up . . . Antithrombotic Trialist Collaboration suggests doses less than 75 mg/day not as effec