Consider The Evidence: Med/Peds Journal Roundup

September 10, 2006

Din-o-mite: Intensive Lipid Lowering in CHD

Filed under: cardiovascular, CHD, lancet — medblog @ 8:33 pm

Lancet 9/9 – In the latest set of reccomendations from the NCEP ATP, the panel reccomended that patients with CHD or risk equivalent have a goal LDL of 100mg/dL, with an option of less than 70mg/dL in high-risk patients. Several prior studies have shown that further reductions in LDL may decrese mortality, but further study is needed.

In the most recent issue of the Lancet, Deedwania et al. publish results of the TNT study on the outcomes of this new goal of intensive lipid lowering. The design was a double blind RCT involving 10,000 patients with over a median of 5 years. To fit the inclusion criteria, subjects had to be aged 35-75 with history of MI, revascularization, or angina with objective evidence of atherosclerotic disease. Subjects were randomized to recieve either 10mg or 80mg of atorvastatin.

Mean LDL levels were 99mg/dL in the low dose, and 72.6mg/dL in the high dose group. The outcome was a statistically significant decrease in risk for major cardiovascular events in the high dose group. With an absolute risk reduction of 3.5% which is 29% relative. The levels obtained were convenient because they closely reflected the new LDL goals. It seems as if this study does show data to support those reccomendations. The question remains as to whether the results can be generalized to CHD risk equivalents such as diabetes, because the study only included clinically evident coronary disease.

Reduction of low-density lipoprotein cholesterol in patients with coronary heart disease and metabolic syndrome: analysis of the Treating to New Targets study,
The Lancet, Volume 368, Issue 9539, 9 September 2006-15 September 2006, Pages 919-928.
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