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Adobe Flash Player is required to view this feature. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Original Article Intensive Lipid Lowering with Atorvastatin in Patients with Stable Coronary Disease John C.
LaRosa, M.D., Scott M. Grundy, M.D., Ph.D., David D. Waters, M.D., Charles Shear, Ph.D., Philip Barter, M.D., Ph.D., Jean-Charles Fruchart, Pharm.D., Ph.D., Antonio M. Gotto, M.D., D.Phil., Heiner Greten, M.D., John J.P. Sony Bluetooth Usb Adapter Driver there. Kastelein, M.D., James Shepherd, M.D., and Nanette K. Wenger, M.D., for the Treating to New Targets (TNT) Investigators N Engl J Med 2005; 352:1425-1435 DOI: 10.1056/NEJMoa050461. Methods A total of 10,001 patients with clinically evident CHD and LDL cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) were randomly assigned to double-blind therapy and received either 10 mg or 80 mg of atorvastatin per day.
Patients were followed for a median of 4.9 years. The primary end point was the occurrence of a first major cardiovascular event, defined as death from CHD, nonfatal non–procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke. Results The mean LDL cholesterol levels were 77 mg per deciliter (2.0 mmol per liter) during treatment with 80 mg of atorvastatin and 101 mg per deciliter (2.6 mmol per liter) during treatment with 10 mg of atorvastatin. The incidence of persistent elevations in liver aminotransferase levels was 0.2 percent in the group given 10 mg of atorvastatin and 1.2 percent in the group given 80 mg of atorvastatin (P.
The value of lowering low-density lipoprotein (LDL) cholesterol levels in preventing major cardiovascular events and stroke has been well documented. Recent studies have raised the issue of optimal treatment targets for patients with coronary heart disease (CHD). The value of reducing LDL cholesterol levels substantially below 100 mg per deciliter (2.6 mmol per liter) in patients with CHD, particularly those with stable nonacute disease, has not been clearly demonstrated. The Third Report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel and the most recent guidelines of the Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice have recommended an LDL cholesterol level of less than 100 mg per deciliter as the goal of therapy for patients at high risk for CHD. On the basis of data from the Heart Protection Study (HPS) and the Pravastatin or Atorvastatin Evaluation and Infection Trial (PROVE IT), the NCEP in conjunction with the American Heart Association and the American College of Cardiology subsequently introduced a more aggressive, but optional, LDL cholesterol goal of less than 70 mg per deciliter (1.8 mmol per liter) for patients at very high risk for CHD, even if baseline LDL cholesterol levels were below 100 mg per deciliter. However, PROVE IT was conducted in a population of patients with acute coronary syndromes who were at very high risk for cardiovascular disease, and although many patients in the HPS who began with an LDL cholesterol level of less than 100 mg per deciliter benefited from statin therapy, this benefit was in comparison with placebo. Thus, there is no definitive evidence that intensive statin therapy, with a goal of reducing LDL cholesterol levels to approximately 70 mg per deciliter, is associated with better outcomes than moderate statin therapy, with a goal of reducing LDL cholesterol levels to about 100 mg per deciliter in patients with stable CHD.