High-dose statins reduce cardiac risk, study says

But some experts say more evidence is necessary before changing treatment guidelines.

By Peggy Peck, AMNews correspondent. April 4, 2005.

Orlando -- Skeptics who questioned the need to treat LDL cholesterol to ever-lower targets finally could have the proof they're waiting for. Results of the aptly-named TNT -- Treating to New Targets -- atorvastatin study effectively demolished any resistance to the concept that lower is better.

Results of the 10,001-patient TNT study were reported last month at a late-breaking clinical trials session at the American College of Cardiology 2005 Scientific Sessions. Results also were released in the online edition of the New England Journal of Medicine.

TNT found that, in a population of patients with stable coronary disease, aggressive lipid-lowering treatment with high-dose atorvastatin (80mg) to mean LDL levels of 77 mg/dL was associated with a 22% reduction in risk of major cardiovascular events compared with patients treated with 10 mg atorvastatin to LDL goals of 100 mg/dL. Absolute reduction was 2.2%.

Additionally, the risk of stroke was reduced by 25% among patients who received 80 mg atorvastatin. The risk for major coronary event was 20% lower in the 80 mg arm compared with the 10 mg arm. Also, the risk of hospitalization for congestive heart failure was reduced by 25% in the 80 mg arm versus the 10 mg treatment group.

John C. LaRosa, MD, from the State University of New York Health Science Center in Brooklyn, presented the results for the TNT investigators and trumpeted the findings: "We have entered a new era in the treatment of established coronary disease from starting at an LDL of 100."