More from Treating to New Target (TNT)

Part of the push for the use of the superstatins was the PROVE-IT (TIMI 23) and the TNT study. They both cause the ATP to review their guidelines, to recommend that LDL-C levels will should be lowered as much as possible, even to below 2.6mMols/L.

I, for one, think that this studies and the ATP current guidelines are probably very much pharmaceutical company driven. The results of the TNT study were presented at the 2005 AHA annual scientific meet. That the makers of the superstatins, want us all to use more statins at higher doses is obvious. It drives the bottom line.

The investigators of the TNT study (TNT studied 10,000 patients with stable CAD) have just published on-line, their post-study analysis of the sub-group of about 5500 patients with metabolic syndrome, to see if this subgroup benefited particularly from extra-lowering of the LDL-C. We all know that patients suffering from the metabolic syndrome are at particular high risk of CVS events. We know that patients with stable CAD and metabolic syndrome are obviously at high risk of CVS events. The investigators found (hardly surprising) that indeed lowering LDL-C aggressively, significantly lowered the MACCE. These findings were presented at the just concluded World Congress of Cardiology annual scientific meeting.

The findings are hardly surprising. One always wonders how much large pharmas have been able to determine outcomes of clinical trials to influence favourable guidelines and so increase the clinical use of their drugs. Where do we draw the line between clever marketing and scientific research.

What I also learnt, just to balance the views, is that in metabolic syndrome, it is not so much the level of LDL-C that is important, but also the type of LDL-C molecule involved. It is wellknown that patients who suffers from the metabolic syndrome, have low HDL-C and raise LDL-C. And what is even worse is that the LDL-C in metabolic syndrome patients, are of the small dense type (the most atherogenic type). Some drugs like fenofibrates, are able to convert the LDL-C to the larger size, less atherogenic type, which may be even more important then lowering LDL-C, which may not be much raised in metabolic syndrome. What I also learn from this TNT post-hoc study is that some studies are analysed and re-analysed (you can also read massaged, and re-massaged) for their benefits. The bright side is that patients on these drugs rest easy that we are better aware of their longterm effects. Well, thre is some good after all.