Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes : The treating to new targets (TNT) study
Identifieur interne : 009F85 ( Main/Exploration ); précédent : 009F84; suivant : 009F86Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes : The treating to new targets (TNT) study
Auteurs : James Shepherd [Royaume-Uni] ; Philip Barter [Australie] ; Rafael Carmena [Espagne] ; Prakash Deedwania [États-Unis] ; Jean-Charles Fruchart [France] ; Steven Haffner [États-Unis] ; Judith Hsia [États-Unis] ; Andrei Breazna [États-Unis] ; John Larosa [États-Unis] ; Scott Grundy [États-Unis] ; David Waters [États-Unis]Source :
- Diabetes care [ 0149-5992 ] ; 2006.
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Abstract
OBJECTIVE - The Treating to New Targets study showed that intensive lipid-lowering therapy with atorvastatin 80 mg/day provides significant clinical benefit beyond that afforded by atorvastatin 10 mg/day in patients with stable coronary heart disease (CHD). The objective of our study was to investigate whether similar benefits of high-dose intensive atorvastatin therapy can be achieved in patients with CHD and diabetes. RESEARCH DESIGN AND METHODS- A total of 1,501 patients with diabetes and CHD, with LDL cholesterol levels of <130 mg/dl, were randomized to double-blind therapy with either atorvastatin 10 (n = 753) or 80 (n = 748) mg/day. Patients were followed for a median of 4.9 years. The primary end point was the time to first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke. RESULTS- End-of-treatment mean LDL cholesterol levels were 98.6 mg/dl with atorvastatin 10 mg and 77.0 mg/dl with atorvastatin 80 mg. A primary event occurred in 135 patients (17.9%) receiving atorvastatin 10 mg, compared with 103 patients (13.8%) receiving atorvastatin 80 mg (hazard ratio 0.75 [95% CI 0.58-0.97], P = 0.026). Significant differences between the groups in favor of atorvastatin 80 mg were also observed for time to cerebrovascular event (0.69 [0.48-0.98], P = 0.037) and any cardiovascular event (0.85 [0.73-1.00], P = 0.044). There were no significant differences between the treatment groups in the rates of treatment-related adverse events and persistent elevations in liver enzymes. CONCLUSIONS- Among patients with clinically evident CHD and diabetes, intensive therapy with atorvastatin 80 mg significantly reduced the rate of major cardiovascular events by 25% compared with atorvastatin 10 mg.
Affiliations:
- Australie, Espagne, France, Royaume-Uni, États-Unis
- Californie, Hauts-de-France, Nord-Pas-de-Calais, Nouvelle-Galles du Sud, Texas, Écosse, État de New York
- Glasgow, Lille, Sydney
- Université de Glasgow, Université de Sydney
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aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Barter, Philip" sort="Barter, Philip" uniqKey="Barter P" first="Philip" last="Barter">Philip Barter</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>The Heart Research Institute, Department of Medicine, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>2 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Carmena, Rafael" sort="Carmena, Rafael" uniqKey="Carmena R" first="Rafael" last="Carmena">Rafael Carmena</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Endocrinology Department, Clinic University Hospital, University of Valencia</s1><s2>Valencia</s2><s3>ESP</s3><sZ>3 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Valencia</wicri:noRegion></affiliation></author><author><name sortKey="Deedwania, Prakash" sort="Deedwania, Prakash" uniqKey="Deedwania P" first="Prakash" last="Deedwania">Prakash Deedwania</name><affiliation wicri:level="2"><inist:fA14 i1="04"><s1>Cardiology Division, Veterans Affairs Central California Health Care, University of California San Francisco School of Medicine</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Fruchart, Jean Charles" sort="Fruchart, Jean Charles" uniqKey="Fruchart J" first="Jean-Charles" last="Fruchart">Jean-Charles Fruchart</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Lipoprotein and Atherosclerosis Research Unit, Institut National de la Santé et de la Recherche Médicale, Pasteur Institute</s1><s2>Lille</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Haffner, Steven" sort="Haffner, Steven" uniqKey="Haffner S" first="Steven" last="Haffner">Steven Haffner</name><affiliation wicri:level="2"><inist:fA14 i1="06"><s1>Department of Medicine, University of Texas Health Science Center</s1><s2>San Antonio, Texas</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Hsia, Judith" sort="Hsia, Judith" uniqKey="Hsia J" first="Judith" last="Hsia">Judith Hsia</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Division of Cardiology, George Washington University Medical Center</s1><s2>Washington, DC</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Washington, DC</wicri:noRegion></affiliation></author><author><name sortKey="Breazna, Andrei" sort="Breazna, Andrei" uniqKey="Breazna A" first="Andrei" last="Breazna">Andrei Breazna</name><affiliation wicri:level="2"><inist:fA14 i1="08"><s1>Biometrics Department, Pfizer</s1><s2>New York, New York</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Larosa, John" sort="Larosa, John" uniqKey="Larosa J" first="John" last="Larosa">John Larosa</name><affiliation wicri:level="2"><inist:fA14 i1="09"><s1>State University of New York Downstate Medical Center, State University of New York Health Science Center</s1><s2>Brooklyn, New York</s2><s3>USA</s3><sZ>9 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Grundy, Scott" sort="Grundy, Scott" uniqKey="Grundy S" first="Scott" last="Grundy">Scott Grundy</name><affiliation wicri:level="2"><inist:fA14 i1="10"><s1>Center for Human Nutrition, Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center</s1><s2>Dallas, Texas</s2><s3>USA</s3><sZ>10 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Waters, David" sort="Waters, David" uniqKey="Waters D" first="David" last="Waters">David Waters</name><affiliation wicri:level="2"><inist:fA14 i1="11"><s1>Division of Cardiology, School of Medicine, San Francisco General Hospital, University of California San Francisco School of Medicine</s1><s2>San Francisco, California</s2><s3>USA</s3><sZ>11 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Diabetes care</title><title level="j" type="abbreviated">Diabetes care</title><idno type="ISSN">0149-5992</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Diabetes care</title><title level="j" type="abbreviated">Diabetes care</title><idno type="ISSN">0149-5992</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Atorvastatin</term><term>Cholesterol LDL</term><term>Coronary heart disease</term><term>Diabetes mellitus</term><term>Human</term><term>Posology</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Cardiopathie coronaire</term><term>Cholestérol LDL</term><term>Homme</term><term>Diabète</term><term>Traitement</term><term>Posologie</term><term>Atorvastatine</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term><term>Diabète</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">OBJECTIVE - The Treating to New Targets study showed that intensive lipid-lowering therapy with atorvastatin 80 mg/day provides significant clinical benefit beyond that afforded by atorvastatin 10 mg/day in patients with stable coronary heart disease (CHD). The objective of our study was to investigate whether similar benefits of high-dose intensive atorvastatin therapy can be achieved in patients with CHD and diabetes. RESEARCH DESIGN AND METHODS- A total of 1,501 patients with diabetes and CHD, with LDL cholesterol levels of <130 mg/dl, were randomized to double-blind therapy with either atorvastatin 10 (n = 753) or 80 (n = 748) mg/day. Patients were followed for a median of 4.9 years. The primary end point was the time to first major cardiovascular event, defined as death from CHD, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke. RESULTS- End-of-treatment mean LDL cholesterol levels were 98.6 mg/dl with atorvastatin 10 mg and 77.0 mg/dl with atorvastatin 80 mg. A primary event occurred in 135 patients (17.9%) receiving atorvastatin 10 mg, compared with 103 patients (13.8%) receiving atorvastatin 80 mg (hazard ratio 0.75 [95% CI 0.58-0.97], P = 0.026). Significant differences between the groups in favor of atorvastatin 80 mg were also observed for time to cerebrovascular event (0.69 [0.48-0.98], P = 0.037) and any cardiovascular event (0.85 [0.73-1.00], P = 0.044). There were no significant differences between the treatment groups in the rates of treatment-related adverse events and persistent elevations in liver enzymes. CONCLUSIONS- Among patients with clinically evident CHD and diabetes, intensive therapy with atorvastatin 80 mg significantly reduced the rate of major cardiovascular events by 25% compared with atorvastatin 10 mg.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Espagne</li><li>France</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Californie</li><li>Hauts-de-France</li><li>Nord-Pas-de-Calais</li><li>Nouvelle-Galles du Sud</li><li>Texas</li><li>Écosse</li><li>État de New York</li></region><settlement><li>Glasgow</li><li>Lille</li><li>Sydney</li></settlement><orgName><li>Université de Glasgow</li><li>Université de Sydney</li></orgName></list><tree><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Shepherd, James" sort="Shepherd, James" uniqKey="Shepherd J" first="James" last="Shepherd">James Shepherd</name></region></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Barter, Philip" sort="Barter, Philip" uniqKey="Barter P" first="Philip" last="Barter">Philip Barter</name></region></country><country name="Espagne"><noRegion><name sortKey="Carmena, Rafael" sort="Carmena, Rafael" uniqKey="Carmena R" first="Rafael" last="Carmena">Rafael Carmena</name></noRegion></country><country name="États-Unis"><region name="Californie"><name sortKey="Deedwania, Prakash" sort="Deedwania, Prakash" uniqKey="Deedwania P" first="Prakash" last="Deedwania">Prakash Deedwania</name></region><name sortKey="Breazna, Andrei" sort="Breazna, Andrei" uniqKey="Breazna A" first="Andrei" last="Breazna">Andrei Breazna</name><name sortKey="Grundy, Scott" sort="Grundy, Scott" uniqKey="Grundy S" first="Scott" last="Grundy">Scott Grundy</name><name sortKey="Haffner, Steven" sort="Haffner, Steven" uniqKey="Haffner S" first="Steven" last="Haffner">Steven Haffner</name><name sortKey="Hsia, Judith" sort="Hsia, Judith" uniqKey="Hsia J" first="Judith" last="Hsia">Judith Hsia</name><name sortKey="Larosa, John" sort="Larosa, John" uniqKey="Larosa J" first="John" last="Larosa">John Larosa</name><name sortKey="Waters, David" sort="Waters, David" uniqKey="Waters D" first="David" last="Waters">David Waters</name></country><country name="France"><region name="Hauts-de-France"><name sortKey="Fruchart, Jean Charles" sort="Fruchart, Jean Charles" uniqKey="Fruchart J" first="Jean-Charles" last="Fruchart">Jean-Charles Fruchart</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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