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ASCOT Lancet, April 2003 n=10,305

ASCOT Lancet, April 2003 n=10,305. Evidence for: primary prevention of CHD and stroke in high risk , middle aged, hypertensive, male patients with TC <6.5mmol/L Questions remaining : women n=1942; adverse & long term effects;

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ASCOT Lancet, April 2003 n=10,305

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  1. ASCOT Lancet,April 2003 n=10,305 • Evidence for:primary prevention of CHD and stroke in highrisk, • middle aged, hypertensive, male patients with TC <6.5mmol/L • Questions remaining: women n=1942; 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,TC<6.5mmol/L) Atorvastatin 10mg/d over average 3.3yrs NNT=NS NNT=91 NNT=143 Older males with multiple risk factors benefit.

  2. PROVE-ITNEJM,April, 2004 n=4,162 2yrs • Intensive vs moderate lipid lowering in high risk ACS pt • LDL: 2.74 baseline mmol/L  1.60atorv 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 NNT=NS NNT=26 (RRR=15%) NNH=46 Monitor for SE if using higher doses

  3. What about younger diabetics with no risk factors??

  4. TNTNEJM,April 2005 n=10,001 4.9yr • Intensive lipid lowering in stable CHD (n=15,464 - 8wk run-in) • LDL: 3.9 baseline mmol/L 2.0atorv80mg vs 2.6 atorv 10mg;Age 35-75, ~61 • 1o end point: “CHD Death, CV Event or Procedure, Stroke” • CV & Stroke events; NNT=46 / 4.9yr; • LFT's NNH=100; 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 NNT=26 / 4.9yr (RRR=20%) NNT=NS LFTs 3xNNH=100  CV events;  ADRs; NO difference in all-cause death

  5. IDEALJAMA,Nov 2005 n=8888 4.8yr • Intensive lipid lowering in previous MI pts (open label trial) • LDL: 3.14 baseline mmol/L 2.1atorv80mg vs 2.7 simv 20-40mg;Age<80, ~62 • 1o Primary: Coronary Death, nonfatal MI or cardiac resusc.9.3 vs 10.4% NS • 2o Major vascular events (1o & stroke) NNT=59/4.8yr;MI6 vs 7.2% NNT=84 • LFT's NNH=112; All-cause death8.2 vs 8.4% or CV death5 vs4.9 butat least  non-CV death 3.2 vs 3.5 NS Atorvastatin 80mg/d $87 vs Simv 20-40mg/day $41 % patients NNT=59 / 4.8yr (RRR=13%) NNT=NS LFTs 3xNNH=112  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

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