There
is overwhelming evidence from a large number of randomized clinical
end point trials, showing the established benefits of statins
in the prevention of cardio- and cerebrovascular events in patients
with documented history of coronary heart disease. However, only
a relatively small number of studies has been published on primary
prevention of cardiovascular events by statins in patients with
slightly elevated or rather normal values of LDL-cholesterol (LDL-C).
This
presentation will briefly review data from early clinical studies
using statin treatment in patients without documented coronary
heart disease: The West of Scotland Coronary Prevention Study
(WOSCOPS) in high-risk patients treated with pravastatin and the
Air Force/Texas Coronary Atherosclerosis Prevention Study (AF/TexCAPS)
in a rather low risk population treated with lovastatin. The presentation
will focus on more detailed data from two recently published studies:
The MRC/BHF Heart Protection Study (HPS) which included a sub-population
of patients without history of coronary artery disease treated
with simvastatin, and the Lipid Lowering Arm of the Anglo-Scandinavian
Cardiac Outcome Trial (ASCOT-LLA). The ASCOT study randomized
20,000 hypertensive patients to various blood pressure-lowering
regimens. Half of them with LDL-C levels below those which needed
treatment according to applicable guidelines were randomized to
10 mg atorvastatin or placebo. The lipid-lowering arm was discontinued
prematurely because of a highly significant difference between
the incidence for clinical end points in Atorvastatin-treated
patients compared to those on placebo; the underlying study investigating
the effect of various antihypertensive treatments remained unblinded
and continues as planned.
All
these studies clearly demonstrate clinical benefits of statin
treatment in the respective patient populations. Especially results
from the ASCOT-LLA study indicate that there is a need for a review
of current treatment guidelines for patients with only slightly
elevated cholesterol levels who in usual praxis would not be treated
with lipid-lowering medication. The results also underline the
importance of putting the patients global risk for major cardio-
and cerebrovascular events into the centre for the decision on
the appropriate medical treatment, strengthening the rationale
behind recent updates of most treatment guidelines for cardiovascular
prevention.
