Title: ASCOT%20Lancet,%20April%202003%20n=10,305
1ASCOT Lancet, April 2003 n10,305
- Evidence for primary prevention of CHD and
stroke in high risk, - middle aged, hypertensive, male patients with
TC lt6.5mmol/L - Questions remaining women n1942 adverse long
term effects - safety and efficacy of titrating dose to attain
targets magnitude/
1o Prevention in high risk (Average 3.7 risk
factors in addition to HTN) (HTN,male/female,age
63 40-79,TClt6.5mmol/L) Atorvastatin 10mg/d over
average 3.3yrs
NNTNS
NNT91
NNT143
Older males with multiple risk factors benefit.
2PROVE-ITNEJM, April, 2004 n4,162 2yrs
- Intensive vs moderate lipid lowering in high risk
ACS pt - LDL 2.74 baseline mmol/L ? 1.60 atorv 80mg vs
2.46 pravastatin 40mg - 1o end point Death or CV Event all-cause
mortality, MI, unstable angina,
revascularization, and stroke Mean age
58 over 2years
Atorvastatin 80mg/d 87 vs Pravastatin 40mg/d 42
After an Acute Coronary Syndrome (ACS)
patients
NNTNS
NNT26 (RRR15)
NNH46
Monitor for SE if using higher doses
3What about younger diabetics with no risk
factors??
4TNTNEJM, April 2005 n10,001 4.9yr
- Intensive lipid lowering in stable CHD (n15,464
- 8wk run-in) - LDL 3.9 baseline mmol/L ? 2.0 atorv 80mg vs 2.6
atorv 10mgAge 35-75, 61 - 1o end point CHD Death, CV Event or Procedure,
Stroke - ?CV Stroke events NNT46 / 4.9yr
- ?LFT's NNH100 All-cause death ? 5.7 vs 5.6
BUT ? non-CV death 3.2 vs 2.5 NS
Atorvastatin 80mg/d 87 vs 10mg/day 67
patients
NNT26 / 4.9yr (RRR20)
NNTNS
LFTs 3xNNH100
? CV events ? ADRs NO difference in all-cause
death
5IDEALJAMA, Nov 2005 n8888 4.8yr
- Intensive lipid lowering in previous MI pts
(open label trial) - LDL 3.14 baseline mmol/L? 2.1 atorv 80mg vs 2.7
simv 20-40mgAgelt80, 62 - 1o Primary Coronary Death, nonfatal MI or
cardiac resusc. 9.3 vs 10.4 NS - 2o ?Major vascular events (1o stroke)
NNT59/4.8yr?MI6 vs 7.2 NNT84 - ?LFT's NNH112 All-cause death ? 8.2 vs 8.4
or CV death ? 5 vs4.9 but at least ? non-CV
death 3.2 vs 3.5 NS
Atorvastatin 80mg/d 87 vs Simv 20-40mg/day 41
patients
NNT59 / 4.8yr (RRR13)
NNTNS
LFTs 3xNNH112
? CV events ? ADRs NO difference in all-cause
death
6Highest risk benefit most!
LDL Outcome Data
7page 55
NNT based on risk
8page 11
Statins best outcome evidenceAge up to age 80
(HPS) Low risk women no/? benefit 20 benefit a
lot 10 small benefit