稳定性冠心病患者强化降脂.pptVIP

TNT: Treating to New Targets TNT: Design TNT: Baseline characteristics TNT: CV history of participants TNT: Baseline lipids TNT: 非心源性死亡率 TNT: 对治疗的耐受性 TNT: 降低LDL-C治疗的扩展的确切益处 已超越现有指南 * 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 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 benefit 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 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(%) Patient population 250 centers in 14 countries(N = 10,001) LDL 130–250 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. LaRosa JC et al. N Engl J Med. 2005;352. Atorvastatin Atorvastatin Characteristics 10 mg (N = 5006) 80 mg (N = 4995) Age (yr) 60.9±8.8 61.2±8.8 Male sex (%) 80.8 81.2 White race (%) 94.1 94.1 Systolic BP (mm Hg) 131±17 131±17 Diastolic BP (mm Hg) 78±10 78±10 BMI (kg/m2) 28.6±4.7 28.4±4.5 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 hypertension 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 LaRosa JC et al. N Engl J Med. 2005;352. Atorvastatin Atorvastatin Lipids (mg/dL) 10 mg (N = 5006) 80 mg (N = 4995) LDL cholesterol 98±18 97±18