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Atorvastatina 80 mg riduce anche il rischio di eventi cardiovascolari successivi al primo

Il trattamento aggressivo della colesterolemia riduce non solo il rischio di un primo evento cardiovascolare, ma diminuisce anche la probabilità di recidive. E' quanto emerge da una nuova analisi dei dati del TNT (Treating to new targets trial) che prende in considerazione anche gli eventi cardiovascolari successivi al primo che era l'end point primario dello studio di confronto con le due dosi di atorvastatina. Secondo gli Autori, limitarsi all'analisi del primo evento sottostima il beneficio in termini clinici ed economici della terapia ipocolesterolemizzante aggressiva.

Comparison of 80 versus 10 mg of atorvastatin on occurrence of cardiovascular events after the first event (from the Treating to New Targets [TNT] trial)

LaRosa JC, Deedwania PC, Shepherd J, Wenger NK, Greten H, DeMicco DA, Breazna A; TNT Investigators.

Am J Cardiol 2010;105:283-287

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 10 mg 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 10 mg 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 80 mg, the relative risk of a first recurrent event was significantly decreased compared to those receiving atorvastatin 10 mg. 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 > or = 65 years of age compared to younger patients. In conclusion, treatment with atorvastatin 80 mg continued to significantly decrease the risk of any cardiovascular event over time compared to atorvastatin 10 mg 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.

Am J Cardiol 2010;105:283-287