Lower is better: implications of the Treating to New Targets (TNT) study for Canadian patients

Area of Science:

• Cardiology
• Clinical Trials
• Pharmacotherapy

Background:

• Recent clinical trials suggest benefits of lowering low-density lipoprotein cholesterol (LDL-C) below current targets.
• Favorable surrogate and clinical endpoints have been observed with more intensive LDL-C reduction.

Purpose of the Study:

• To confirm if aggressive cholesterol lowering to a mean LDL-C of 2.0 mmol/L improves clinical outcomes.
• To compare high-dose (80 mg) versus standard-dose (10 mg) atorvastatin in high-risk coronary artery disease patients.

Main Methods:

• The Treating to New Targets (TNT) study involved high-risk patients with coronary artery disease.
• Patients were randomized to receive atorvastatin 80 mg daily or atorvastatin 10 mg daily.

Main Results:

• Aggressive lowering to a mean LDL-C of 2.0 mmol/L with atorvastatin 80 mg resulted in improved clinical outcomes compared to 2.5 mmol/L with atorvastatin 10 mg.
• Approximately 50% of high-risk patients may not achieve an LDL-C target below 2.0 mmol/L with monotherapy using potent statins.
• Registry data indicate that 50% of patients do not achieve the current LDL-C target of 2.5 mmol/L.

Conclusions:

• Achieving lower LDL-C targets (<2.0 mmol/L) poses therapeutic challenges for high-risk patients.
• A significant care gap exists in achieving recommended LDL-C targets, necessitating discussion of causes and remedies.