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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 wellbelow 100 mg/dL could yield an incremental clinical benefitParticipa
2、nts: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 stroke,Benefit of intensive LDL-C lowering:Accumulating evidence,LaRosa JC et al.N Engl J Med.2005;
3、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 population250 centers in 14 countries(N=10,001)LDL 130250 mg/dLTG 600 mg/dL,Atorvastatin 10 mg,Atorvastatin 80 mg,4.9 years,Atorvastatin 10 mg
4、,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)60.98.861.28.8Male sex(%)80.881.2White race(%)94.194.1Systolic BP(mm Hg)1311713117Diastolic BP(mm Hg)781
5、0 7810BMI(kg/m2)28.64.728.44.5,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 smoker13.413.4Former smoker63.363.2Systemic hypertension54.453.9Diabetes mellitus15.015.0MI57.759.0Angina81.281.8Cerebrovascular event5.35
6、.1PAD11.412.1CHF8.17.6Arrhythmia18.518.2Coronary revascularization Angioplasty54.353.8 Bypass46.746.4,TNT:Baseline lipids,LaRosa JC et al.N Engl J Med.2005;352.,Atorvastatin Atorvastatin Lipids(mg/dL)10 mg(N=5006)80 mg(N=4995)LDL cholesterol98189718Total cholesterol17524 17524Triglycerides15172 1517
7、2HDL cholesterol4711 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1.51.71.13(0.83,1.55)0.42其它非外伤原因0.91.21.35(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5.88.1 3x ULN0.21.20.001,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(%),
