LDL-C Lowering Provides Benefits in Primary Prevention of CVD
LDL-cholesterol lowering has proven short- and long-term benefits for the primary prevention of cardiovascular disease among individuals with primary elevations of LDL-C ≥190 mg/dL, according to a study published Sept. 6 in Circulation. These finding may help reinforce current recommendations for this patient population.
Using post-hoc analyses from the West of Scotland Coronary Prevention Study randomized trial, Antonio J. Vallejo-Vaz, MD, et al., assessed the benefits of LDL-C lowering on cardiovascular outcomes among individuals with primary elevations of LDL-C ≥190 mg/dL without pre-exiting vascular disease at baseline. Approximately, 6,600 men (45-64 years old) were enrolled in the study and randomized to either pravastatin 40 mg/d or placebo. The effect of pravastatin vs. placebo on coronary heart disease (CHD) and major adverse cardiovascular events (MACE) was assessed over the 4.9-year trial phase. Mortality outcomes were also looked at over a 20-year follow-up period.
Results showed that among 5,529 individuals without vascular disease, pravastatin consistently reduced the risk of both CHD (27 percent) and MACE (25 percent) among those with and without LDL-C ≥190 mg/dL (p-interaction > 0.9).
Among participants with LDL-C ≥190 mg/dL, pravastatin reduced the risk of coronary heart disease by 27 percent and MACE by 25 percent during the initial trial phase. The risk of coronary heart disease death, cardiovascular death and all-cause mortality was reduced by 28 percent, 25 percent (p=0.009) and 18 percent (p=0.004) over the total 20-year follow-up.
Observational data also found that among the individuals with LDL-C ≥190 mg/dL, reductions in LDL-C of greater than 30 percent or 39 mg/dL were associated with a lower risk of CHD and MACE compared with placebo.
“A major strength of the present analysis is that it explores a group of higher risk individuals (LDL-C ≥190 mg/dL) specifically highlighted in guidelines, but one in which clinical trial evidence is lacking,” the study authors write. “Thus, the present results from a randomized trial provide novel information and evidence to support guideline recommendations.”
Keywords: Pravastatin, Cholesterol, LDL, omega-Chloroacetophenone, Follow-Up Studies, Coronary Disease, Risk, Cardiovascular Diseases, Primary Prevention
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