Copyright © 2000 by the European Society of Cardiology.
Application of the National Cholesterol Education Program and joint European treatment criteria and clinical benefit in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)
a Weill Medical College of Cornell University, New York, New York, U.S.A.
b The Heart and Vascular Institute of Texas, San Antonio, Texas, U.S.A.
c Medical Research Laboratories, Highland Heights, Kentucky, U.S.A.
d Merck & Co., Inc. U.S.A.
e University of North Texas Health Science Center, Fort Worth, Texas, U.S.A.
f Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, U.S.A.
g University of Pennsylvania, Philadelphia, emeritus, U.S.A.
revised May 22, 2000; accepted May 24, 2000
Abstract
Aims The Air Force/Texas Coronary Atherosclerosis Prevention Study reported that diet with lovastatin, 20–40mg daily, reduced the risk for a first coronary event by 37%. Because only 17% of this cohort would have qualified for drug therapy according to current U.S. guidelines, we assessed clinical benefit by risk categories.
Methods and Results The main outcome measures were event rates of first acute major coronary events stratified by National Cholesterol Education Program and European criteria and target goal. Both those who would and would not be eligible for drug therapy, according to National Cholesterol Education Program guidelines, benefited from intervention. As expected, drug-eligible participants (event rate: lovastatin 1%/year, placebo 1·87%/year [relative risk 0·53, 95% confidence interval: 0·33, 0·84]) were at greater absolute risk for acute major coronary events than non-eligible participants (lovastatin 0·62%/year, placebo 0·93%/year [relative risk 0·67, 95% confidence interval: 0·51, 0·88]). Similar results were found using European guidelines for coronary risk management. Treatment to a target goal suggested a non-significant trend to greater benefit.
Conclusions The consistent relative benefit across risk categories suggests that it may be possible to improve identification of at-risk persons who would benefit from primary prevention, and to recommend appropriate goals of such treatment.
Key Words: Atherosclerosis, primary prevention, lovastatin, guidelines
f1 Correspondence: Antonio M. Gotto, c/o Jesse Jou, Weill Medical College of Cornell University, 445 E. 69th Street, Olin Hall Room 205, New York, NY 10021, U.S.A.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. H. O'Keefe Jr, L. Cordain, W. H. Harris, R. M. Moe, and R. Vogel Reply J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1732 - 1732. [Full Text]
|
|
|
|
 |
|
 M Higgins Patients, families and populations at high risk for coronary heart disease Eur. Heart J., September 2, 2001; 22(18): 1682 - 1690. [PDF]
|
|
|
|
|
|
D. Mulcahy Statins and cardiovascular disease--major therapeutic advances but are we seizing the moment? Eur. Heart J., July 1, 2001; 22(13): 1065 - 1066. [PDF]
|
|
|
|
 |
|
 R. B. Kalmansohn, R. W. Kalmansohn, and D. L. Schiff Scientific Communications: Revised Indications for Statin Therapies Angiology, May 1, 2001; 52(5): 367 - 368. [PDF]
|
|
|
|
|
|
J.C. Fruchart A need to redefine the consensus on the use of statins in coronary heart disease prevention Eur. Heart J., October 1, 2000; 21(19): 1572 - 1573. [PDF]
|
|