ASCOT%20Lancet,%20April%202003%20n=10,305

1
ASCOT 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.
2
PROVE-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
3
What about younger diabetics with no risk
factors??
4
TNTNEJM, 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
5
IDEALJAMA, 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
6
Highest risk benefit most!
LDL Outcome Data
7
page 55
NNT based on risk
8
page 11
Statins best outcome evidenceAge up to age 80
(HPS) Low risk women no/? benefit 20 benefit a
lot 10 small benefit