Wenger NK, Lewis SJ, Welty FK, Herrington DM, Bittner V.

Beneficial effects of aggressive LDL cholesterol lowering in women with stable coronary heart disease in the Treating to New Targets (TNT) study

Objective This pre-specified secondary analysis of the Treating to New Targets (TNT) study afforded us the opportunity to examine 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 CHD were randomised to double-blind therapy with atorvastatin 10 or 80 mg/day for a median follow-up of 4.9 years. Results In women and men, intensive therapy with atorvastatin 80 mg significantly decreased 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] 0.54-1.00, p = 0.049). In men, the corresponding rate reductions were 21% and 2.2% (HR 0.79, 95% CI 0.69-0.91, 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 noncardiovascular 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.