Beneficial effects of aggressive low-density lipoprotein cholesterol lowering in women with stable coronary heart disease in the Treating to New Targets (TNT) study
- N K Wenger1,
- S J Lewis2,
- F K Welty3,
- D M Herrington4,
- V Bittner on behalf of the TNT Steering Committee and Investigators5
- 1Emory University School of Medicine, Atlanta, GA, USA
- 2Northwest Cardiovascular Institute, Portland, OR, USA
- 3Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- 4Wake Forest University School of Medicine, Winston-Salem, NC, USA
- 5University of Alabama at Birmingham, Birmingham, AL, USA
- Professor N K Wenger, Emory University School of Medicine, 49 Jesse Hill Jr Drive, SE Atlanta, GA 30303, USA;
- Accepted 20 November 2007
- Published Online First 10 December 2007
Objective: To examine by secondary analysis of the Treating to New Targets (TNT) study whether the benefits of intensive versus standard levels of lipid lowering are equally applicable to women.
Methods: A total of 10 001 patients (1902 women) with stable coronary heart disease (CHD) were randomised to double-blind treatment with atorvastatin 10 or 80 mg/day for a median follow-up of 4.9 years.
Results: In women and men, intensive treatment with atorvastatin 80 mg significantly reduced the rate of major cardiovascular events compared with atorvastatin 10 mg. Among women, the relative and absolute reductions were 27% and 2.7%, respectively (hazard ratio (HR) = 0.73, 95% confidence interval (CI) 0.54 to 1.00, p = 0.049). In men, the corresponding rate reductions were 21% and 2.2% (HR = 0.79, 95% CI 0.69 to 0.91, p = 0.001). The number needed to treat value (to prevent one cardiovascular event over 4.9 years compared with patients treated with atorvastatin 10 mg) for atorvastatin 80 mg was 29 for women and 30 for men. Rates of death of non-cardiovascular origin in the atorvastatin 80 mg and atorvastatin 10 mg were 3.6% and 1.6%, respectively (p = 0.004) among women, and 2.8% and 3.1% (p = 0.47) among men.
Conclusion: Intensive lipid-lowering treatment with atorvastatin 80 mg produced significant reductions in relative risk for major cardiovascular events compared with atorvastatin 10 mg in both women and men with stable CHD.
The authors had full access to the data and take responsibility for its integrity. All authors have read and agree to the manuscript as written.
Competing interests: NKW has received consulting fees from Sanofi Aventis, Merck, Schering-Plough, Bristol Myers Squibb, Eli Lilly, SmithKline Beecham, DuPont Pharma, AstraZeneca, Abbott, Pfizer, Nitromed, Kos, and CV Therapeutics; lecture fees from Pfizer, Aventis, Novartis, Merck, Nitromed, Eli Lilly, DuPont Pharma, and CV Therapeutics; and grant support from Pfizer, Merck, Eli Lilly, and NHLBI. SJL has received consulting fees from Pfizer, Merck, Bristol-Myers Squibb, and AstraZeneca; lecture fees from Pfizer, Merck, Bristol-Myers Squibb, and AstraZeneca; and grant support from Pfizer and AstraZeneca. DMH has received consulting fees from Merck; and grant support from Pfizer; VB has received consulting fees from CV Therapeutics, Reliant Pharmaceuticals, Pfizer, Novartis, and Abbott; lecture fees from Merck, Merck Schering-Plough, Pfizer, and KOS Pharmaceuticals; and research grants from Pfizer, NIH/Abbott, Atherogenics and Merck; FKW has received consulting fees from Pfizer, and AstraZeneca; lecture fees from Abbott, AstraZeneca, and Pfizer; and research grants from Reliant.
Ethics approval: The study was approved by local research ethics committee or institutional review board at each study centre.