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Treating to New Targets (TNT) Study: does lowering low-density lipoprotein cholesterol levels below currently recommended guidelines yield incremental clinical benefit?

      Abstract

      The Treating to New Targets (TNT) trial is a parallel-group study that has randomized 10,003 patients from 14 countries to double-blind treatment with either atorvastatin 10 or 80 mg. During the double-blind period, low-density lipoprotein (LDL) cholesterol levels are expected to reach approximate mean values of 100 mg/dl (2.6 mmol/L) for the low-dose atorvastatin group and 75 mg/dl (1.9 mmol/L) for the high-dose group. Randomized patients are expected to be followed for an average of 5 years. The primary end point is the time to occurrence of a major cardiovascular event, defined as coronary heart disease death, nonfatal myocardial infarction, resuscitated cardiac arrest, or stroke. The large patient numbers in the TNT study and long follow-up should ensure that there is adequate power to definitively determine if reducing LDL cholesterol levels to approximately 75 mg/dl (1.9 mmol/L) can provide additional clinical benefit.
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      References

        • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
        Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • American Diabetes Association
        Management of dyslipidemia in adults with diabetes.
        Diabetes Care. 1999; 22: S56-S59
        • Heart Protection Study Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20, 536 high-risk individuals.
        Lancet. 2002; 360: 7-22
        • Grundy S.M.
        Statin trials and goals of cholesterol-lowering therapy.
        Circulation. 1998; 97: 1436-1439
        • Jones P.H.
        Lipid-lowering treatment in coronary artery disease.
        Drugs. 2000; 59: 1127-1135
        • Scandinavian Simvastatin Survival Study Group
        Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease.
        Lancet. 1994; 344: 1383-1389
        • Sacks F.M.
        • Pfeffer M.A.
        • Moyé L.A.
        • Rouleau J.L.
        • Rutherford J.D.
        • Cole T.G.
        • Brown L.
        • Warnica J.W.
        • Arnold J.M.O.
        • Wun C.C.
        • Davis B.R.
        • Braunwald E.B.
        • Cholesterol and Recurrent Events Trial Investigators
        The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.
        N Engl J Med. 1996; 335: 1001-1009
        • The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group
        Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels.
        N Engl J Med. 1998; 339: 1349-1357