WOSCOPS

In the general population for primary prevention of CHD The West of Scotland Coronary Prevention Study (WOSCOPS) (9), Air Force/Texas coronary atherosclerosis Prevention study (AFCAPS/TexCAPS) (10), and the completed but unpublished MEGA study in Japan (A. Nakamura, presented to AHA Scientific Sessions, November 2005). 

Atherosclerotic cardiovascular disease HMG co-A reductase inhibitors Lovastatin Pravastatin Simvastatin Primary and secondary prevention of coronary heart disease (CHD) reduced hospitalizations, percutaneous transluminal coronary angioplasties (PTCA), and coronary artery bypass graft surgeries (CABG) reduced all-cause mortality 4S AFCAPS CARE LIPID WOSCOPS >30,000 7,8... 

More controversial is the extent to which primary prevention (treatment of clinically unaffected patients with moderate elevation of cholesterol levels) should include drugs, and whether secondary prevention should ever start with drugs rather than diet. Dietary treatment can lower cholesterol levels in committed subjects, and is obviously less costly than drug treatment. Unforhmately numerous studies have shown that over any substantial period of time (e.g. one year) diet has no clinically significant influence on plasma cholesterol and the wait for diet to have an effect often results in patients being lost from hospital follow-up after their initial myocardial infarction. Evidence comes from the WOSCOPS stud) in which pravastatin 40 mg/day and placebo were compared in 6590 men age 50-70 with LDL cholesterol 4-6 mmol/1 pravastatin reduced coronary heart disease (fatal and nonfatal events) by 31%. The authors estimated that treatment of 1000 such subjects each year would prevent 20 myocardial infarctions. Concerns that primary prevention could have a net adverse outcome (that cholesterol reduction increased the risk of cancer or violent deaths) have been laid to rest by a number of outcome trials. 

WOSCOPS = West of Scotland Coronary Prevention Study. Shepherd J et al 1995 Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. New England Journal of Medicine 333 1301-1307. 

Increased hsCRP concentrations have also been implicated in the development of type 2 diabetes mellitus. Prospective studies have found strong, graded relationships between hsCRP and incident diabetes, which in many instances persisted after adjustment for body mass index and other covariates.In WOSCOPS, the top quintile of hsCRP... 

AECAPS/TexCAPS = Air ForceAexas Coronary Atherosclerosis Prevention Study (Downs et ah, 1998) Helsinki = The Helsinki Heart Study (Frick et al., 1 987) LRC-CPPT = The Lipid Research Clinics Coronary Primary Prevention Trial (insull et al., 1984) Oslo = The Oslo Study (Hjermann et ah, 1988) WOSCOPS = The West of Scotland Coronary Prevention Study (Shepherd et al., 1995) ALLHAT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial approximately 13-15% of patients had a history of coronary heart disease (CHD) events are CHD events only WHI = Women s Health initiative RRR = relative risk reduction ARR = absolute risk reduction NNT = number needed to treat NA = not available CEE = conjugated equine estrogen MPA = medroxyprogesterone acetate CARDS = Collaborative Atorvastatin Diabetes Study (presented at the 2004 American Diabetes Association meeting). 

VA-HIT Veterans Administration High-Density Lipoprotein Cholesterol (HDL-C) Intervention Trial VCAM-1 Vascular cell adhesion molecule VEGF Vascular endothelial growth factor VLDL Very low-density lipoproteins WHI Women s Health Initiative WHO World Health Organization WOSCOPS West of Scotland Coronary Prevention Study... 

Primary prevention trials such as Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) (i i, 72), West of Scotland Coronary Prevention Study Group (WOSCOPS) (13,14), and the... 

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