Targets for low-density lipoprotein cholesterol levels in patients with stable coronary heart disease: where are we now after the "treating to new targets" (TNT) trial?

T he Third Report of the National Cholesterol Education ProgramAdult Treatment Panel (NCEPATP III) and the Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice recommended a low-density lipoprotein cholesterol (LDL-C) target of <100 mg/dl for patients with coronary heart disease (CHD). Indeed, the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) and the Aggressive LipidLowering Initiation Abates New Cardiac Events (ALLIANCE) studies showed that in CHD patients who achieved this NCEP-ATP III goal with atorvastatin there was a significant reduction in vascular events compared with “usual” care. Recently, the NCEP recommended an optional more aggressive LDL-C goal of <70 mg/dl for patients at particularly high risk. This recommendation was mainly based on the results of the Pravastatin or Atorvastatin Evaluation and Infection Trial (PROVEIT) and the Heart Protection Study (HPS). In PROVE-IT, the reduction in LDL-C was significantly (p=0.001) greater with atorvastatin 80 mg/day (104 to 62 mg/dl) than with pravastatin 40 mg/day (104 to 96 mg/dl) Targets for Low-Density Lipoprotein Cholesterol Levels in Patients with Stable Coronary Heart Disease: Where are we Now After the “Treating to New Targets” (TNT) Trial?