TRS2P and LDL-C alone or in combination for predicting absolute benefits from additional LDL-C lowering: Analysis from the TNT trial.

Abstract Background and aims Despite trial evidence, high intensity statins are underutilized in routine clinical practice. This study sought to assess the individual and joint contributions of the TRS2P score as a measure of residual risk and LDL-C levels to benefits from further LDL-C lowering in the TNT trial. Methods A total of 9,980 patients were divided into 4 groups based on TRS2P and LDL-C at baseline: Results Percentage reductions in LDL-C with atorvastatin 80 mg were consistent across groups, whereas absolute reductions were approximately 11 mg/dL greater when LDL-C was ≥median. Despite atorvastatin 10 mg, either TRS2P ≥median or LDL-C ≥median were associated with more events and highest when both were ≥median (groups 1-4; 21.5%, 28.1%, 36.3%, and 40.5%, respectively; p-trend median (7.2%, group 4), NNT 78 vs. 14 (p-interaction Conclusions Measures of residual risk as well LDL-C identify patients who remain at high risk despite statins with the combination identifying those who derive the greatest benefits from even modest additional LDL-C lowering. Attention to residual risk as well as LDL-C may further help to optimize guideline implementation. ClinicalTrials.gov NCT00327691.