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1、TNT:Treating to New Targets治疗达到新目标研究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稳定性冠心病患者强化降脂治疗的新数据治疗的新数据TNT:Treating to New TargetsLaRosa JC et al.N Engl J Med.2005;352.Hypothesis:Lowering LDL-C levels to wellbelow 100 mg/dL could yield an incremental c
2、linical benefitParticipants:10,001 patients with stable CHDand LDL-C 130-250 mg/dLTreatments:Atorvastatin 10 mg and 80 mgMedian follow-up:4.9 yearsPrimary outcome:CHD death,MI,resuscitation aftercardiac arrest,fatal/nonfatal strokeBenefit of intensive LDL-C lowering:Accumulating evidenceLaRosa JC et
3、 al.N Engl J Med.2005;352.030510152025StatinPlaceboHPSCARELIPIDHPSCARELIPID4S4SLDL cholesterol(mg/dL)02101901701501301109070Event(%)TNT:Baseline characteristicsLaRosa JC et al.N Engl J Med.2005;352.Atorvastatin Atorvastatin Characteristics 10 mg(N=5006)80 mg(N=4995)Age(yr)60.98.861.28.8Male sex(%)80
4、.881.2White race(%)94.194.1Systolic BP(mm Hg)1311713117Diastolic BP(mm Hg)7810 7810BMI(kg/m2)28.64.728.44.5TNT:CV history of participantsLaRosa JC et al.N Engl J Med.2005;352.%Atorvastatin%Atorvastatin 10 mg(N=5006)80 mg(N=4995)Current smoker13.413.4Former smoker63.363.2Systemic hypertension54.453.9
5、Diabetes mellitus15.015.0MI57.759.0Angina81.281.8Cerebrovascular event5.35.1PAD11.412.1CHF8.17.6Arrhythmia18.518.2Coronary revascularization Angioplasty54.353.8 Bypass46.746.4TNT:Baseline lipidsLaRosa JC et al.N Engl J Med.2005;352.Atorvastatin Atorvastatin Lipids(mg/dL)10 mg(N=5006)80 mg(N=4995)LDL
6、 cholesterol98189718Total cholesterol17524 17524Triglycerides15172 15172HDL cholesterol4711 4711TNT:对治疗的耐受性对治疗的耐受性LaRosa JC et al.N Engl J Med.2005;352.%阿托伐他汀阿托伐他汀%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5.88.1 0.001停药率5.37.2 3x ULN0.21.20.001 TNT:降低降低LDL-C治疗的扩展的确切益处治疗的扩展的确切益处 已超越现有指南已超越现有指南LaRosa JC et al.N Engl J Med.2005;352.030510152025他汀安慰剂HPSCARELIPIDHPSCARELIPID4S4SLDL 胆固醇(mg/dL)02101901701501301109070TNT(80 mg 阿托伐他汀阿托伐他汀)TNT(10 mg 阿托伐他汀阿托伐他汀)事件(%)