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Lipid-Lowering Therapy Beneficial for Low-Risk Patients.

Lowering cholesterol has been shown to improve outcomes in patients with established coronary artery disease and in middle-aged men with very high cholesterol and other coronary risk factors. In this double-blind study, investigators assessed the benefit of lipid-lowering therapy in people without known coronary heart disease and with "average" serum cholesterol levels. Participants completed a 12-week American Heart Association step-1 diet and then were randomized to lovastatin or placebo.

Overall, 5,608 men (mean age, 57) and 997 women (mean age, 63) received lovastatin (20 to 40 mg/day) or placebo. At one year, lovastatin reduced LDL by 25 percent and total cholesterol by 18 percent and increased HDL by 6 percent. After an average follow-up of 5.2 years, the lovastatin-treated group experienced a 37 percent lower rate of first acute major coronary event than did the placebo group (P=.001). Lovastatin also significantly reduced the risk of specific events: MI (RR, 0.60), unstable angina (RR, 0.68), coronary revascularization (0.67), and fatal and nonfatal coronary events (.75). The effect of treatment was greater on women than men (46 percent vs. 37 percent reduction in risk), but due to a low event rate, the difference was not statistically significant. The researchers estimate that treating 1,000 people with lovastatin for five years could prevent 12 MIs, 7 episodes of unstable angina, and 17 coronary revascularizations.

Comment: These data, which are consistent with findings from previous primary prevention trials, show that lovastatin has a major impact on reducing coronary events in both men and women. This trial extends current indications for statin therapy for primary prevention of coronary events to patients with more average cholesterol levels.

— KA Eagle

Published in Journal Watch Cardiology July 10, 1998

Citation(s):

Downs JR et al for the AFCAPS/TexCAPS Research Group. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS. JAMA 1998 May 27 279 1615 -1622.

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