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: 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.