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The West of Scotland Coronary Prevention Study: Long-Term Results
The benefits of statins for primary prevention of coronary heart disease stand the test of time.
Results published in 1995 from the West of Scotland Coronary Prevention Study (WOSCOPS), a randomized, double-blind, placebo-controlled clinical trial of pravastatin in middle-aged men without a history of MI, demonstrated a significant benefit after approximately 5 years of treatment (Journal Watch Cardiology Dec 1 1995). Now, the WOSCOPS investigators report outcomes over the subsequent 10 years.
About one third of the study subjects took statins during the post-trial period; the percentages were slightly higher in those who were originally randomized to pravastatin. During follow-up (mean, 13.2 years for cancer and 14.7 years for other outcomes), 18.8% of the participants originally assigned to pravastatin died, compared with 20.5% of those originally assigned to placebo. During the entire 15-year study period, the original pravastatin group had significant reductions in death from all causes (hazard ratio, 0.88), death from cardiovascular causes (HR, 0.81), and the composite of death from coronary heart disease and nonfatal MI (HR, 0.73), compared with the original placebo group. The greatest benefits with pravastatin occurred during the trial period — e.g., the reduction in death from cardiovascular causes was 34% during the trial and 14% in the post-trial period. Pravastatin treatment was not associated with an increase in cancer rates.
Comment: This study extends the findings of a classic statin trial: The benefits for primary prevention of coronary heart disease manifested during the trial were maintained — and perhaps expanded — through 10 years of follow-up. These results add to an already large literature supporting the value of statins for secondary prevention.
Published in Journal Watch Cardiology October 10, 2007
Citation(s):
Ford I et al. for the West of Scotland Coronary Prevention Study Group. Long-term follow-up of the West of Scotland Coronary Prevention Study. N Engl J Med 2007 Oct 11; 357:1477.
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