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Analyses of randomized clinical trials are usually restricted to examination of time to first event. However, because many patients have multiple events, this approach precludes much potentially useful clinical and economic data. To assess the effect on overall disease burden in the Treating to New Targets (TNT) study, we evaluated the effect of treatment with atorvastatin 80 versus 10mg in the period after the occurrence of a first cardiovascular event. In TNT, 10,001 patients with stable coronary heart disease received double-blind therapy with atorvastatin 80 or 10mg and were followed for 4.9 years. Post hoc time-to-event analysis was used to estimate separate hazard ratios for time to any first, second, third, fourth, and fifth recurrent cardiovascular events. During TNT, 3,082 patients had a first recurrent cardiovascular event, with 1,516, 698, 345, and 197 developing second, third, fourth, and fifth recurrent events, respectively. In patients receiving atorvastatin 80mg, the relative risk of a first recurrent event was significantly decreased compared to those receiving atorvastatin 10mg. Significant benefit with the 80-mg dose was also observed for second, third, fourth, and fifth recurrent events. Similar findings were recorded in 5,854 patients with type 2 diabetes mellitus and/or metabolic syndrome and in 3,809 patients ≥65 years of age compared to younger patients. In conclusion, treatment with atorvastatin 80mg continued to significantly decrease the risk of any cardiovascular event over time compared to atorvastatin 10mg in patients who had survived previous events. In TNT, analyses limited to the primary end point significantly underestimated the decrease in total cardiovascular disease burden achieved by intensive low-density lipoprotein cholesterol lowering (Figs 1 and 2).
Figure 1: Risk decrease in cardiovascular events. (Reprinted from LaRosa JC, Deedwania PC, Shepherd J, et al. Comparison of 80 versus 10mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial). Am J Cardiol. 2010;105:283-287, with permission from Elsevier.)
Figure 2: Risk decrease in cardiovascular events in patients (A) with type 2 diabetes and/or metabolic syndrome and (B) ≥65 years of age. (Reprinted from LaRosa JC, Deedwania PC, Shepherd J, et al. Comparison of 80 versus 10mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial). Am J Cardiol. 2010;105:283-287, with permission from Elsevier.)
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