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Effect of High-Dose Atorvastatin on Hospitalizations for Heart Failure: Subgroup Analysis of the Treating to New Targets (TNT) Study
Open accessAbstract
Background— Statins reduce the rate of major cardiovascular events in high-risk patients, but their potential benefit as treatment for heart failure (HF) is less clear. Methods and Results— Patients (n=10 001) with stable coronary disease were randomized to treatment with atorvastatin 80 or 10 mg/d and followed up for a median of 4.9 years. A history of HF was present in 7.8% of patients. A known ejection fraction <30% and advanced HF were exclusion criteria for the study. A predefined secondary end point of the study was hospitalization for HF. The incidence of hospitalization for HF was 2.4% in the 80-mg arm and 3.3% in the 10-mg arm (hazard ratio, 0.74; 95% confidence interval, 0.59 to 0.94; P =0.0116). The treatment effect of the higher dose was more marked in patients with a history of HF: 17.3% versus 10.6% in the 10- and 80-mg arms, respectively (hazard ratio, 0.59; 95% confidence interval, 0.4 to 0.88; P =0.009). Among patients without a history of HF, the rates of hospitalization for HF were much lower: 1.8% in the 80-mg group and 2.0% in the 10-mg group (hazard ratio, 0.87; 95% confidence interval, 0.64 to 1.16; P =0.34). Only one third of patients hospitalized for HF had evidence of preceding angina or myocardial infarction during the study period. Blood pressure was almost identical during follow-up in the treatment groups. Conclusions— Compared with a lower dose, intensive treatment with atorvastatin in patients with stable coronary disease significantly reduces hospitalizations for HF. In a post hoc analysis, this benefit was observed only in patients with a history of HF. The mechanism accounting for this benefit is unlikely to be due primarily to a reduction in interim coronary events or differences in blood pressure.
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“The clinical benefit of adding ezetimibe was consistent across patient subgroups [299,444] and also led to a reduction of total CV events [445], stroke [446], and rehospitalizations [447].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [444]
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“The more intense approach reduced the incidence of hospitalization due to HF by an average of 27% in patients with acute and stable CAD without previous HF. 358,370-372”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [372]
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Metadata
- Authors
- Khush, K. K., Waters, D. D., Bittner, V., Deedwania, P. C., Kastelein, J. J. P., Lewis, S. J., & Wenger, N. K.
- Affiliations
- Emory University (US)
- ORCID
- Venue
- Circulation
- Published
- 2007-02-06
- Volume
- 115
- Issue
- 5
- Pages
- 576-583
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2103918731
- Cited by
- 172
- References
- 36
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 5 · 2022: 1 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 5 · 2014: 10 · 2013: 10 · 2012: 7
- FWCI
- 30.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- atorvastatin, high-intensity statin therapy, heart failure hospitalization, stable coronary artery disease, statin dose comparison, secondary prevention, cardiovascular risk reduction
- MeSH terms
- Atorvastatin, Aged, Female, Follow-Up Studies, Heart Failure, Heptanoic Acids, Hospitalization, Humans, Male, Middle Aged, Pyrroles, Drug Delivery Systems
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