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

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 9980 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 <0.0001. Although relative benefits were similar, absolute risk reduction from atorvastatin 80 mg was lowest when both scores were median (7.2%, group 4), NNT 78 vs. 14 (p-interaction <0.0001).

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.