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TNT analysis: Higher triglyceride-rich lipoprotein-cholesterol associated with increased cardiovascular risk

This post hoc analysis of the Treating to New Targets (TNT) study showed that reduction in triglyceride-rich lipoprotein-cholesterol (TRL-C) with atorvastatin reduced the risk of major adverse cardiovascular events. After a run-in phase on atorvastatin 10 mg/day, the TNT study randomized patients with coronary heart disease and low-density lipoprotein cholesterol (LDL-C) <130 mg/dL to treatment with atorvastatin 10 mg/day (n=5006) or atorvastatin 80 mg/day (n=4995). The primary study endpoint was a composite of coronary heart disease death, non-fatal myocardial infarction, resuscitated cardiac arrest, or stroke (MACE). This analysis investigated the impact of both doses of atorvastatin on TRL-C, calculated as total cholesterol minus high-density lipoprotein cholesterol minus LDL-C. Treatment with atorvastatin 10 mg/day reduced TRL-C by 10.7%; the higher dose led to an additional 15.4% reduction in TRL-C. In adjusted analyses, a 1 standard deviation percentage reduction in TRL-C with atorvastatin led to a lower risk of MACE (Hazard ratio 0.93, 95%CI 0.86-1.00, p=0.0482). This effect was independent of the reduction in LDL-C and of similar magnitude to that observed per 1 standard deviation reduction in LDL-C (HR 0.89, 95%CI 0.83-0.95, p=0.0008). In conclusion, this analysis provides evidence that the cardiovascular benefit of statin therapy is associated with reduction in both LDL-C and TRL-C.
Triglyceride-rich lipoprotein cholesterol and risk of cardiovascular events among patients receiving statin therapy in the Treating to New Targets (TNT) Trial.

Vallejo-Vaz AJ, Fayyad R, Boekholdt SM et al